Exon skipping compositions for treating muscular dystrophy

ABSTRACT

Antisense molecules capable of binding to a selected target site in the human dystrophin gene to induce exon 44 skipping are described.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/213,607, filed on Mar. 14, 2014, now pending, which claims thebenefit of U.S. Provisional Application No. 61/784,547, filed on Mar.14, 2013. The contents of the aforementioned applications are herebyincorporated by reference.

FIELD OF THE INVENTION

The present invention relates to novel antisense compounds andcompositions suitable for facilitating exon skipping in the humandystrophin gene. It also provides methods for inducing exon skippingusing the novel antisense compositions adapted for use in the methods ofthe invention.

STATEMENT REGARDING SEQUENCE LISTING

The instant application contains a Sequence Listing which has beensubmitted electronically in ASCII format and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Jun. 30, 2016, isnamed AVN_013ACN_Sequence_Listing.txt and is 11 Kilobytes in size. TheSequence Listing is being submitted by EFS Web and is herebyincorporated by reference into the specification.

BACKGROUND OF THE INVENTION

Antisense technologies are being developed using a range of chemistriesto affect gene expression at a variety of different levels(transcription, splicing, stability, translation). Much of that researchhas focused on the use of antisense compounds to correct or compensatefor abnormal or disease-associated genes in a wide range of indications.Antisense molecules are able to inhibit gene expression withspecificity, and because of this, many research efforts concerningoligonucleotides as modulators of gene expression have focused oninhibiting the expression of targeted genes or the function ofcis-acting elements. The antisense oligonucleotides are typicallydirected against RNA, either the sense strand (e.g., mRNA), orminus-strand in the case of some viral RNA targets. To achieve a desiredeffect of specific gene down-regulation, the oligonucleotides generallypromote the decay of the targeted mRNA, block translation of the mRNA orblock the function of cis-acting RNA elements, thereby effectivelypreventing either de novo synthesis of the target protein or replicationof the viral RNA.

However, such techniques are not useful where the object is toup-regulate production of the native protein or compensate for mutationsthat induce premature termination of translation, such as nonsense orframe-shifting mutations. In these cases, the defective gene transcriptshould not be subjected to targeted degradation or steric inhibition, sothe antisense oligonucleotide chemistry should not promote target mRNAdecay or block translation.

In a variety of genetic diseases, the effects of mutations on theeventual expression of a gene can be modulated through a process oftargeted exon skipping during the splicing process. The splicing processis directed by complex multi-component machinery that brings adjacentexon-intron junctions in pre-mRNA into close proximity and performscleavage of phosphodiester bonds at the ends of the introns with theirsubsequent reformation between exons that are to be spliced together.This complex and highly precise process is mediated by sequence motifsin the pre-mRNA that are relatively short, semi-conserved RNA segmentsto which various nuclear splicing factors that are then involved in thesplicing reactions bind. By changing the way the splicing machineryreads or recognizes the motifs involved in pre-mRNA processing, it ispossible to create differentially spliced mRNA molecules. It has nowbeen recognized that the majority of human genes are alternativelyspliced during normal gene expression, although the mechanisms involvedhave not been identified. Bennett et al. (U.S. Pat. No. 6,210,892)describe antisense modulation of wild-type cellular mRNA processingusing antisense oligonucleotide analogs that do not induce RNAseH-mediated cleavage of the target RNA. This finds utility in being ableto generate alternatively spliced mRNAs that lack specific exons (e.g.,as described by (Sazani, Kole, et al. 2007) for the generation ofsoluble TNF superfamily receptors that lack exons encoding membranespanning domains.

In cases where a normally functional protein is prematurely terminatedbecause of mutations therein, a means for restoring some functionalprotein production through antisense technology has been shown to bepossible through intervention during the splicing processes, and that ifexons associated with disease-causing mutations can be specificallydeleted from some genes, a shortened protein product can sometimes beproduced that has similar biological properties of the native protein orhas sufficient biological activity to ameliorate the disease caused bymutations associated with the exon (see e.g., Sierakowska, Sambade etal. 1996; Wilton, Lloyd et al. 1999; van Deutekom, Bremmer-Bout et al.2001; Lu, Mann et al. 2003; Aartsma-Rus, Janson et al. 2004). Kole etal. (U.S. Pat. Nos. 5,627,274; 5,916,808; 5,976,879; and 5,665,593)disclose methods of combating aberrant splicing using modified antisenseoligonucleotide analogs that do not promote decay of the targetedpre-mRNA. Bennett et al. (U.S. Pat. No. 6,210,892) describe antisensemodulation of wild-type cellular mRNA processing also using antisenseoligonucleotide analogs that do not induce RNAse H-mediated cleavage ofthe target RNA.

The process of targeted exon skipping is likely to be particularlyuseful in long genes where there are many exons and introns, where thereis redundancy in the genetic constitution of the exons or where aprotein is able to function without one or more particular exons.Efforts to redirect gene processing for the treatment of geneticdiseases associated with truncations caused by mutations in variousgenes have focused on the use of antisense oligonucleotides that either:(1) fully or partially overlap with the elements involved in thesplicing process; or (2) bind to the pre-mRNA at a position sufficientlyclose to the element to disrupt the binding and function of the splicingfactors that would normally mediate a particular splicing reaction whichoccurs at that element.

Duchenne muscular dystrophy (DMD) is caused by a defect in theexpression of the protein dystrophin. The gene encoding the proteincontains 79 exons spread out over more than 2 million nucleotides ofDNA. Any exonic mutation that changes the reading frame of the exon, orintroduces a stop codon, or is characterized by removal of an entire outof frame exon or exons, or duplications of one or more exons, has thepotential to disrupt production of functional dystrophin, resulting inDMD.

A less severe form of muscular dystrophy, Becker muscular dystrophy(BMD) has been found to arise where a mutation, typically a deletion ofone or more exons, results in a correct reading frame along the entiredystrophin transcript, such that translation of mRNA into protein is notprematurely terminated. If the joining of the upstream and downstreamexons in the processing of a mutated dystrophin pre-mRNA maintains thecorrect reading frame of the gene, the result is an mRNA coding for aprotein with a short internal deletion that retains some activity,resulting in a Becker phenotype.

For many years it has been known that deletions of an exon or exonswhich do not alter the reading frame of a dystrophin protein would giverise to a BMD phenotype, whereas an exon deletion that causes aframe-shift will give rise to DMD (Monaco, Bertelson et al. 1988). Ingeneral, dystrophin mutations including point mutations and exondeletions that change the reading frame and thus interrupt properprotein translation result in DMD. It should also be noted that some BMDand DMD patients have exon deletions covering multiple exons.

Modulation of mutant dystrophin pre-mRNA splicing with antisenseoligoribonucleotides has been reported both in vitro and in vivo (seee.g., Matsuo, Masumura et al. 1991; Takeshima, Nishio et al. 1995;Pramono, Takeshima et al. 1996; Dunckley, Eperon et al. 1997; Dunckley,Manoharan et al. 1998; Errington, Mann et al. 2003).

The first example of specific and reproducible exon skipping in the mdxmouse model was reported by Wilton et al. (Wilton, Lloyd et al. 1999).By directing an antisense molecule to the donor splice site, consistentand efficient exon 23 skipping was induced in the dystrophin mRNA within6 hours of treatment of the cultured cells. Wilton et al. also describetargeting the acceptor region of the mouse dystrophin pre-mRNA withlonger antisense oligonucleotides. While the first antisenseoligonucleotide directed at the intron 23 donor splice site inducedconsistent exon skipping in primary cultured myoblasts, this compoundwas found to be much less efficient in immortalized cell culturesexpressing higher levels of dystrophin. However, with refined targetingand antisense oligonucleotide design, the efficiency of specific exonremoval was increased by almost an order of magnitude (Mann, Honeyman etal. 2002).

Recent studies have begun to address the challenge of achievingsustained dystrophin expression accompanied by minimal adverse effectsin tissues affected by the absence of dystrophin. Intramuscularinjection of an antisense oligonucleotide targeted to exon 51 (PRO051)into the tibialis anterior muscle in four patients with DMD resulted inspecific skipping of exon 51 without any clinically apparent adverseeffects (Mann, Honeyman et al. 2002; van Deutekom, Janson et al. 2007).Studies looking at systemic delivery of an antisense phosphorodiamidatemorpholino oligomer conjugated to a cell-penetrating peptide (PPMO)targeted to exon 23 in mdx mice produced high and sustained dystrophinprotein production in skeletal and cardiac muscles without detectabletoxicity (Jearawiriyapaisarn, Moulton et al. 2008; Wu, Moulton et al.2008; Yin, Moulton et al. 2008).

Recent clinical trials testing the safety and efficacy of spliceswitching oligonucleotides (SSOs) for the treatment of DMD are based onSSO technology to induce alternative splicing of pre-mRNAs by stericblockade of the spliceosome (Cirak et al., 2011; Goemans et al., 2011;Kinali et al., 2009; van Deutekom et al., 2007).

Despite these successes, there remains a need for improved antisenseoligomers targeted to multiple dystrophin exons and improved deliverycompositions and methods for DMD therapeutic applications.

SUMMARY OF THE INVENTION

According to one aspect, the invention provides antisense moleculescapable of binding to a selected target in human dystrophin pre-mRNA toinduce exon skipping. In another aspect, the invention provides two ormore antisense oligonucleotides which are used together to induce singleor multiple exon skipping. For example, exon skipping of a single ormultiple exons can be achieved by linking together two or more antisenseoligonucleotide molecules.

In another aspect, the invention relates to an isolated antisenseoligonucleotide of 20 to 50 nucleotides in length, including at least10, 12, 15, 17 or 20 consecutive nucleotides complementary to an exon 44target region of the dystrophin gene designated as an annealing siteselected from the group consisting of: H44A(−07+17) and H44A(+62+89),wherein the antisense oligonucleotide specifically hybridizes to theannealing site inducing exon 44 skipping. In one embodiment, theantisense oligonucleotide is 20 to 30 or 24 to 28 nucleotides in length.Another embodiment of the invention relates to an isolated antisenseoligonucleotide of 20 to 50 nucleotides in length, including at least10, 12, 15, 17 or 20 consecutive nucleotides complementary to an exon 44target region of the dystrophin gene designated as an annealing siteselected from the group consisting of: H44A(−07+17) and H44A(+62+89),wherein the antisense oligonucleotide specifically hybridizes to theannealing site inducing exon 44 skipping. In yet another embodiment, theinvention relates to an isolated antisense oligonucleotide of 20 to 50nucleotides in length, including at least 10, 12, 15, 17 or 20consecutive nucleotides complementary to an exon 44 target region of thedystrophin gene designated as an annealing site selected from the groupconsisting of: H44A(−07+17) and H44A(+62+89), wherein the antisenseoligonucleotide specifically hybridizes to the annealing site inducingexon 53 skipping. In one embodiment, the antisense oligonucleotide is 20to 30 or 24 to 28 nucleotides in length.

In another aspect, the invention relates to an isolated antisenseoligonucleotide of 20 to 50 nucleotides in length, including at least10, 12, 15, 17, or 20 consecutive nucleotides of a nucleotide sequenceselected from the group consisting of: SEQ ID NOs: 1 and 6, wherein theoligonucleotide specifically hybridizes to an exon 44 target region ofthe human dystrophin gene and induces exon 44 skipping. In oneembodiment, the antisense oligonucleotide is 20 to 30 or 24 to 28nucleotides in length. In another embodiment, thymine bases in SEQ IDNOs: 1 and 6 are optionally uracil.

Other embodiments of the invention relate to an isolated antisenseoligonucleotide of 20 to 50 nucleotides in length, including at least10, 12, 15, 17, or 20 consecutive nucleotides of a nucleotide sequenceselected from the group consisting of: SEQ ID NOs: 2, 3, 4, 5 and 7,wherein the oligonucleotide specifically hybridizes to an exon 44 targetregion of the Dystrophin gene and induces exon 44 skipping. In oneembodiment, the antisense oligonucleotide is 20 to 30 or 24 to 29nucleotides in length. In another embodiment, thymine bases in SEQ IDNOs: 2, 3, 4, 5 and 7 are optionally uracil.

The present invention includes exemplary antisense sequences targeted toexon 44, such as those identified below.

H44A(-07+17): (SEQ ID NO: 1) 5′-CAGATCTGTCAAATCGCCTGCAGG-3′H44A(-07+20): (SEQ ID NO: 2) 5′-CAACAGATCTGTCAAATCGCCTGCAGG-3′H44A(-07+22): (SEQ ID NO: 3) 5′-CTCAACAGATCTGTCAAATCGCCTGCAGG-3′H44A(+77+101): (SEQ ID NO: 4) 5′-GTGTCTTTCTGAGAAACTGTTCAGC-3′H44A(+64+91): (SEQ ID NO: 5) 5′-GAGAAACTGTTCAGCTTCTGTTAGCCAC-3′H44A(+62+89): (SEQ ID NO: 6) 5′-GAAACTGTTCAGCTTCTGTTAGCCACTG-3′H44A(+62+85)): (SEQ ID NO: 7) 5′-CTGTTCAGCTTCTGTTAGCCACTG-3′

In one embodiment, the antisense oligomer specifically hybridizes toannealing site H44A(−07+17), such as SEQ ID NO: 1. In anotherembodiment, the antisense oligomer specifically hybridizes to annealingsite H44A(+62+89), such as SEQ ID NO: 6.

In another aspect, the invention includes an antisense oligonucleotidecompound that is: (i) composed of morpholino subunits andphosphorus-containing intersubunit linkages joining a morpholinonitrogen of one subunit to a 5′ exocyclic carbon of an adjacent subunit,(ii) containing between 10-50, 15-50, 20-50, 20-30, or 25-35 nucleotidebases, (iii) having a base sequence effective to hybridize to at least10, 12, 15, 17, or 20 consecutive bases of a target sequence indystrophin pre-mRNA and induce exon skipping.

In one aspect, the antisense compound is composed ofphosphorus-containing intersubunit linkages joining a morpholinonitrogen of one subunit to a 5′ exocyclic carbon of an adjacent subunit.The morpholino subunits in the compound may be joined byphosphorodiamidate linkages, in accordance with the structure:

where Y₁=O, Z=O, Pj is a purine or pyrimidine base-pairing moietyeffective to bind, by base-specific hydrogen bonding, to a base in apolynucleotide, and X is alkyl, alkoxy, thioalkoxy, or alkyl amino e.g.,wherein X=NR₂, where each R is independently hydrogen or methyl. Theabove intersubunit linkages, which are uncharged, may be interspersedwith linkages that are positively charged at physiological pH, where thetotal number of positively charged linkages is between 1 and up to allof the total number of intersubunit linkages.

In another exemplary embodiment, the compound is comprised ofintersubunit linkage and terminal modifications as described in U.S.application Ser. No. 13/118,298, which is incorporated herein in itsentirety.

In some embodiments, the antisense oligomers of the invention do notactivate RNase H. In some embodiments, the antisense oligonucleotidescomprise a non-natural backbone. In some embodiments, the sugar moietiesof the oligonucleotide backbone are replaced with non-natural moieties,such as morpholinos. In some embodiments, the antisense oligonucleotideshave the inter-nucleotide linkages of the oligonucleotide backbonereplaced with non-natural inter-nucleotide linkages, such as modifiedphosphates. Exemplary modified phosphates include methyl phosphonates,methyl phosphorothioates, phosphoromorpholidates,phosophropiperazidates, and phosphoroamidates. In some embodiments, theantisense oligonucleotide is a 2′-O-methyl-oligoribonucleotide or apeptide nucleic acid.

In some embodiments, the antisense oligonucleotide is chemically linkedto one or more moieties, such as a polyethylene glycol moiety, orconjugates, such as a arginine-rich cell penetrating peptide (e.g., SEQID NOs: 19-34), that enhance the activity, cellular distribution, orcellular uptake of the antisense oligonucleotide. In one exemplaryembodiment, the arginine-rich polypeptide is covalently coupled at itsN-terminal or C-terminal residue to the 3′ or 5′ end of the antisensecompound. Also in an exemplary embodiment, the antisense compound iscomposed of morpholino subunits and phosphorus-containing intersubunitlinkages joining a morpholino nitrogen of one subunit to a 5′ exocycliccarbon of an adjacent subunit.

In another aspect, the invention provides expression vectors thatincorporate the antisense oligonucleotides described above, e.g., theantisense oligonucleotides of SEQ ID NOs: 1-7. In some embodiments, theexpression vector is a modified retrovirus or non-retroviral vector,such as a adeno-associated viral vector.

In another aspect, the invention provides pharmaceutical compositionsthat include the antisense oligonucleotides described above, and asaline solution that includes a phosphate buffer.

In another aspect, the invention provides antisense molecules selectedand or adapted to aid in the prophylactic or therapeutic treatment of agenetic disorder comprising at least an antisense molecule in a formsuitable for delivery to a patient.

In another aspect, the invention provides a method for treating apatient suffering from a genetic disease wherein there is a mutation ina gene encoding a particular protein and the affect of the mutation canbe abrogated by exon skipping, comprising the steps of: (a) selecting anantisense molecule in accordance with the methods described herein; and(b) administering the molecule to a patient in need of such treatment.The invention also addresses the use of purified and isolated antisenseoligonucleotides of the invention, for the manufacture of a medicamentfor treatment of a genetic disease.

In another aspect, the invention provides a method of treating acondition characterized by muscular dystrophy, such as Duchenne musculardystrophy or Becker muscular dystrophy, which includes administering toa patient an effective amount of an appropriately designed antisenseoligonucleotide of the invention, relevant to the particular geneticlesion in that patient. Further, the invention provides a method forprophylactically treating a patient to prevent or minimize musculardystrophy, such as Duchenne muscular dystrophy or Becker musculardystrophy, by administering to the patient an effective amount of anantisense oligonucleotide or a pharmaceutical composition comprising oneor more of these biological molecules.

In another aspect, the invention also provides kits for treating agenetic disease, which kits comprise at least an antisenseoligonucleotide of the present invention, packaged in a suitablecontainer and instructions for its use.

These and other objects and features will be more fully understood whenthe following detailed description of the invention is read inconjunction with the figures.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1A shows an exemplary morpholino oligomer structure with aphosphorodiamidate linkage.

FIG. 1B shows a conjugate of an arginine-rich peptide and an antisenseoligomer, in accordance with an embodiment of the invention.

FIG. 1C shows a conjugate as in FIG. 1B, wherein the backbone linkagescontain one or more positively charged groups.

FIGS. 1D-G show the repeating subunit segment of exemplary morpholinooligonucleotides, designated D through G.

FIGS. 2 and 3 depict graphs corresponding to experiments showingrelative activities of exemplary antisense oligomers for inducing exon44 skipping in cultured human rhabdomyosarcoma cells. RNA isolated fromrhabdomyosarcoma cells treated with the indicated oligomers wassubjected to exon 44-specific nested RT-PCR amplification, followed bygel electrophoresis and band intensity quantification. Data are plottedas % exon skipping as assessed by PCR, i.e., the band intensity of theexon-skipped product relative to the full-length PCR product. In FIG. 2,H44A(−06+14), H44A(−06+20) and H44A(−09+17) (SEQ ID NOs: 8, 14 and 15,respectively) are published oligomers. In FIG. 3, H44A(+85+104),H44A(+59+85) and H44A(+65+90) (SEQ ID NOs: 9, 16 and 18, respectively)are published oligomers.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present invention relate generally to improvedantisense compounds, and methods of use thereof, which are specificallydesigned to induce exon skipping in the human dystrophin gene.Dystrophin plays a vital role in muscle function, and variousmuscle-related diseases are characterized by mutated forms of this gene.Hence, in certain embodiments, the improved antisense compoundsdescribed herein induce exon skipping in mutated forms of the humandystrophin gene, such as the mutated dystrophin genes found in Duchennemuscular dystrophy (DMD) and Becker muscular dystrophy (BMD).

Due to aberrant mRNA splicing events caused by mutations, these mutatedhuman dystrophin genes either express defective dystrophin protein orexpress no measurable dystrophin at all, a condition that leads tovarious forms of muscular dystrophy. To remedy this condition, theantisense compounds of the present invention hybridize to selectedregions of a pre-processed RNA of a mutated human dystrophin gene,induce exon skipping and differential splicing in that otherwiseaberrantly spliced dystrophin mRNA, and thereby allow muscle cells toproduce an mRNA transcript that encodes a functional dystrophin protein.In certain embodiments, the resulting dystrophin protein is notnecessarily the “wild-type” form of dystrophin, but is rather atruncated, yet functional or semi-functional, form of dystrophin.

By increasing the levels of functional dystrophin protein in musclecells, these and related embodiments are useful in the prophylaxis andtreatment of muscular dystrophy, especially those forms of musculardystrophy, such as DMD and BMD, that are characterized by the expressionof defective dystrophin proteins due to aberrant mRNA splicing. Thespecific oligomers described herein further provide improved,dystrophin-exon-specific targeting over other oligomers in use, andthereby offer significant and practical advantages over alternatemethods of treating relevant forms of muscular dystrophy.

Thus, the invention relates to isolated antisense oligonucleotides of 20to 50 nucleotides in length, including at least 10, 12, 15, 17, 20 ormore, consecutive nucleotides complementary to an exon 44 target regionof the dystrophin gene designated as an annealing site selected from thegroup consisting of: H44A(−07+17) and H44A(+62+89). Antisenseoligonucleotides specifically hybridize to the annealing site, inducingexon 44 skipping. Other antisense oligonucleotides of the invention are20 to 50 nucleotides in length and include at least 10, 12, 15, 17, 20or more, consecutive nucleotides complementary to an exon 44 targetregion of the dystrophin gene designated as an annealing site selectedfrom the group consisting of: H44A(−07+17) and H44A(+62+89). Yet otherantisense oligonucleotides of the invention are 20 to 50 nucleotides inlength and include at least 10, 12, 15, 17, 20 or more, consecutivenucleotides complementary to an exon 44 target region of the dystrophingene designated as an annealing site selected from the group consistingof: H44A(−07+20), H44A(−07+22), H44A(+77+101), H44A(+64+91) andH44A(+62+85).

Other antisense oligonucleotides of the invention are 20 to 50nucleotides in length and include at least 10, 12, 15, 17, 20 or more,consecutive nucleotides of SEQ ID NOs: 1, or 6. Other embodiments relateto antisense oligonucleotides of 20 to 50 nucleotides in length,including at least 10, 12, 15, 17, 20 or more, consecutive nucleotidesof SEQ ID NOs: 2-5 and 7. In some embodiments, thymine bases in SEQ IDNOs: 1-7 are optionally uracil.

Exemplary antisense oligomers of the invention are set forth below:

H44A(-07+17): (SEQ ID NO: 1) 5′-CAGATCTGTCAAATCGCCTGCAGG-3′H44A(-07+20): (SEQ ID NO: 2) 5′-CAACAGATCTGTCAAATCGCCTGCAGG-3′H44A(-07+22): (SEQ ID NO: 3) 5′-CTCAACAGATCTGTCAAATCGCCTGCAGG-3′H44A(+77+101): (SEQ ID NO: 4) 5′-GTGTCTTTCTGAGAAACTGTTCAGC-3′H44A(+64+91): (SEQ ID NO: 5) 5′-GAGAAACTGTTCAGCTTCTGTTAGCCAC-3′H44A(+62+89): (SEQ ID NO: 6) 5′-GAAACTGTTCAGCTTCTGTTAGCCACTG-3′H44A(+62+85)): (SEQ ID NO: 7) 5′-CTGTTCAGCTTCTGTTAGCCACTG-3′

In a preferred embodiment, the antisense oligomer specificallyhybridizes to the annealing site H44A(−07+17), such as SEQ ID NO: 1. Inyet another preferred embodiment, the antisense oligomer specificallyhybridizes to an annealing site H44A(+62+89), such as SEQ ID NO: 6. Inanother embodiment, the antisense oligomer is selected from SEQ ID NOS:1 and 6.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by those of ordinary skillin the art to which the invention belongs. Although any methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of the present invention, preferred methods andmaterials are described. For the purposes of the present invention, thefollowing terms are defined below.

I. DEFINITIONS

By “about” is meant a quantity, level, value, number, frequency,percentage, dimension, size, amount, weight or length that varies by asmuch as 30, 25, 20, 15, 10, 9, 8, 7, 6, 5, 4, 3, 2 or 1% to a referencequantity, level, value, number, frequency, percentage, dimension, size,amount, weight or length.

The terms “complementary” and “complementarity” refer to polynucleotides(i.e., a sequence of nucleotides) related by base-pairing rules. Forexample, the sequence “T-G-A (5′-3′),” is complementary to the sequence“T-C-A (5′-3′).” Complementarity may be “partial,” in which only some ofthe nucleic acids' bases are matched according to base pairing rules.Or, there may be “complete” or “total” complementarity between thenucleic acids. The degree of complementarity between nucleic acidstrands has significant effects on the efficiency and strength ofhybridization between nucleic acid strands. While perfectcomplementarity is often desired, some embodiments can include one ormore but preferably 6, 5, 4, 3, 2, or 1 mismatches with respect to thetarget RNA. Variations at any location within the oligomer are included.In certain embodiments, variations in sequence near the termini of anoligomer are generally preferable to variations in the interior, and ifpresent are typically within about 6, 5, 4, 3, 2, or 1 nucleotides ofthe 5′ and/or 3′ terminus.

The terms “cell penetrating peptide” and “CPP” are used interchangeablyand refer to cationic cell penetrating peptides, also called transportpeptides, carrier peptides, or peptide transduction domains. Thepeptides, as shown herein, have the capability of inducing cellpenetration within 100% of cells of a given cell culture population andallow macromolecular translocation within multiple tissues in vivo uponsystemic administration. A preferred CPP embodiment is an arginine-richpeptide as described further below.

The terms “antisense oligomer” and “antisense compound” and “antisenseoligonucleotide” are used interchangeably and refer to a sequence ofcyclic subunits, each bearing a base-pairing moiety, linked byintersubunit linkages that allow the base-pairing moieties to hybridizeto a target sequence in a nucleic acid (typically an RNA) byWatson-Crick base pairing, to form a nucleic acid:oligomer heteroduplexwithin the target sequence. The cyclic subunits are based on ribose oranother pentose sugar or, in a preferred embodiment, a morpholino group(see description of morpholino oligomers below). The oligomer may haveexact or near sequence complementarity to the target sequence;variations in sequence near the termini of an oligomer are generallypreferable to variations in the interior.

Such an antisense oligomer can be designed to block or inhibittranslation of mRNA or to inhibit natural pre-mRNA splice processing,and may be said to be “directed to” or “targeted against” a targetsequence with which it hybridizes. The target sequence is typically aregion including an AUG start codon of an mRNA, a TranslationSuppressing Oligomer, or splice site of a pre-processed mRNA, a SpliceSuppressing Oligomer (SSO). The target sequence for a splice site mayinclude an mRNA sequence having its 5′ end 1 to about 25 base pairsdownstream of a normal splice acceptor junction in a preprocessed mRNA.A preferred target sequence is any region of a preprocessed mRNA thatincludes a splice site or is contained entirely within an exon codingsequence or spans a splice acceptor or donor site. An oligomer is moregenerally said to be “targeted against” a biologically relevant target,such as a protein, virus, or bacteria, when it is targeted against thenucleic acid of the target in the manner described above.

The terms “morpholino oligomer” or “PMO” (phosphoramidate- orphosphorodiamidate morpholino oligomer) refer to an oligonucleotideanalog composed of morpholino subunit structures, where (i) thestructures are linked together by phosphorus-containing linkages, one tothree atoms long, preferably two atoms long, and preferably uncharged orcationic, joining the morpholino nitrogen of one subunit to a 5′exocyclic carbon of an adjacent subunit, and (ii) each morpholino ringbears a purine or pyrimidine base-pairing moiety effective to bind, bybase specific hydrogen bonding, to a base in a polynucleotide. See, forexample, the structure in FIG. 1A, which shows a preferredphosphorodiamidate linkage type. Variations can be made to this linkageas long as they do not interfere with binding or activity. For example,the oxygen attached to phosphorus may be substituted with sulfur(thiophosphorodiamidate). The 5′ oxygen may be substituted with amino orlower alkyl substituted amino. The pendant nitrogen attached tophosphorus may be unsubstituted, monosubstituted, or disubstituted with(optionally substituted) lower alkyl. The purine or pyrimidine basepairing moiety is typically adenine, cytosine, guanine, uracil, thymineor inosine. The synthesis, structures, and binding characteristics ofmorpholino oligomers are detailed in U.S. Pat. Nos. 5,698,685,5,217,866, 5,142,047, 5,034,506, 5,166,315, 5,521,063, 5,506,337,8,076,476, 8,299,206 and 7,943,762 (cationic linkages), all of which areincorporated herein by reference. Modified intersubunit linkages andterminal groups are detailed in PCT application US2011/038459 andpublication WO/2011/150408 which are incorporated herein by reference intheir entirety.

An “amino acid subunit” or “amino acid residue” can refer to an α-aminoacid residue (—CO—CHR—NH—) or a β- or other amino acid residue (e.g.—CO—(CH₂)_(n)CHR—NH—), where R is a side chain (which may includehydrogen) and n is 1 to 6, preferably 1 to 4.

The term “naturally occurring amino acid” refers to an amino acidpresent in proteins found in nature. The term “non-natural amino acids”refers to those amino acids not present in proteins found in nature,examples include beta-alanine (β-Ala), 6-aminohexanoic acid (Ahx) and6-aminopentanoic acid.

An “exon” refers to a defined section of nucleic acid that encodes for aprotein, or a nucleic acid sequence that is represented in the matureform of an RNA molecule after either portions of a pre-processed (orprecursor) RNA have been removed by splicing. The mature RNA moleculecan be a messenger RNA (mRNA) or a functional form of a non-coding RNA,such as rRNA or tRNA. The human dystrophin gene has about 79 exons.

An “intron” refers to a nucleic acid region (within a gene) that is nottranslated into a protein. An intron is a non-coding section that istranscribed into a precursor mRNA (pre-mRNA), and subsequently removedby splicing during formation of the mature RNA.

An “effective amount” or “therapeutically effective amount” refers to anamount of therapeutic compound, such as an antisense oligomer,administered to a mammalian subject, either as a single dose or as partof a series of doses, which is effective to produce a desiredtherapeutic effect. For an antisense oligomer, this effect is typicallybrought about by inhibiting translation or natural splice-processing ofa selected target sequence.

“Exon skipping” refers generally to the process by which an entire exon,or a portion thereof, is removed from a given pre-processed RNA, and isthereby excluded from being present in the mature RNA, such as themature mRNA that is translated into a protein. Hence, the portion of theprotein that is otherwise encoded by the skipped exon is not present inthe expressed form of the protein, typically creating an altered, thoughstill functional, form of the protein. In certain embodiments, the exonbeing skipped is an aberrant exon from the human dystrophin gene, whichmay contain a mutation or other alteration in its sequence thatotherwise causes aberrant splicing. In certain embodiments, the exonbeing skipped is any one or more of exons 1-79 of the dystrophin gene,though exon 44 of the human dystrophin gene is preferred.

“Dystrophin” is a rod-shaped cytoplasmic protein, and a vital part ofthe protein complex that connects the cytoskeleton of a muscle fiber tothe surrounding extracellular matrix through the cell membrane.Dystrophin contains multiple functional domains. For instance,dystrophin contains an actin binding domain at about amino acids 14-240and a central rod domain at about amino acids 253-3040. This largecentral domain is formed by 24 spectrin-like triple-helical elements ofabout 109 amino acids, which have homology to alpha-actinin andspectrin. The repeats are typically interrupted by four proline-richnon-repeat segments, also referred to as hinge regions. Repeats 15 and16 are separated by an 18 amino acid stretch that appears to provide amajor site for proteolytic cleavage of dystrophin. The sequence identitybetween most repeats ranges from 10-25%. One repeat contains threealpha-helices: 1, 2 and 3. Alpha-helices 1 and 3 are each formed by 7helix turns, probably interacting as a coiled-coil through a hydrophobicinterface. Alpha-helix 2 has a more complex structure and is formed bysegments of four and three helix turns, separated by a Glycine orProline residue. Each repeat is encoded by two exons, typicallyinterrupted by an intron between amino acids 47 and 48 in the first partof alpha-helix 2. The other intron is found at different positions inthe repeat, usually scattered over helix-3. Dystrophin also contains acysteine-rich domain at about amino acids 3080-3360), including acysteine-rich segment (i.e., 15 Cysteines in 280 amino acids) showinghomology to the C-terminal domain of the slime mold (Dictyosteliumdiscoideum) alpha-actinin. The carboxy-terminal domain is at about aminoacids 3361-3685.

The amino-terminus of dystrophin binds to F-actin and thecarboxy-terminus binds to the dystrophin-associated protein complex(DAPC) at the sarcolemma. The DAPC includes the dystroglycans,sarcoglycans, integrins and caveolin, and mutations in any of thesecomponents cause autosomally inherited muscular dystrophies. The DAPC isdestabilized when dystrophin is absent, which results in diminishedlevels of the member proteins, and in turn leads to progressive fibredamage and membrane leakage. In various forms of muscular dystrophy,such as Duchenne's muscular dystrophy (DMD) and Becker's musculardystrophy (BMD), muscle cells produce an altered and functionallydefective form of dystrophin, or no dystrophin at all, mainly due tomutations in the gene sequence that lead to incorrect splicing. Thepredominant expression of the defective dystrophin protein, or thecomplete lack of dystrophin or a dystrophin-like protein, leads to rapidprogression of muscle degeneration, as noted above. In this regard, a“defective” dystrophin protein may be characterized by the forms ofdystrophin that are produced in certain subjects with DMD or BMD, asknown in the art, or by the absence of detectable dystrophin.

As used herein, the terms “function” and “functional” and the like referto a biological, enzymatic, or therapeutic function.

A “functional” dystrophin protein refers generally to a dystrophinprotein having sufficient biological activity to reduce the progressivedegradation of muscle tissue that is otherwise characteristic ofmuscular dystrophy, typically as compared to the altered or “defective”form of dystrophin protein that is present in certain subjects with DMDor BMD. In certain embodiments, a functional dystrophin protein may haveabout 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% (includingall integers in between) of the in vitro or in vivo biological activityof wild-type dystrophin, as measured according to routine techniques inthe art. As one example, dystrophin-related activity in muscle culturesin vitro can be measured according to myotube size, myofibrilorganization (or disorganization), contractile activity, and spontaneousclustering of acetylcholine receptors (see, e.g., Brown et al., Journalof Cell Science. 112:209-216, 1999). Animal models are also valuableresources for studying the pathogenesis of disease, and provide a meansto test dystrophin-related activity. Two of the most widely used animalmodels for DMD research are the mdx mouse and the golden retrievermuscular dystrophy (GRMD) dog, both of which are dystrophin negative(see, e.g., Collins & Morgan, Int J Exp Pathol 84: 165-172, 2003). Theseand other animal models can be used to measure the functional activityof various dystrophin proteins. Included are truncated forms ofdystrophin, such as those forms that are produced by certain of theexon-skipping antisense compounds of the present invention.

By “isolated” is meant material that is substantially or essentiallyfree from components that normally accompany it in its native state. Forexample, an “isolated polynucleotide,” as used herein, may refer to apolynucleotide that has been purified or removed from the sequences thatflank it in a naturally-occurring state, e.g., a DNA fragment that hasbeen removed from the sequences that are normally adjacent to thefragment.

As used herein, “sufficient length” refers to an antisenseoligonucleotide that is complementary to at least 8, more typically8-30, contiguous nucleobases in a target dystrophin pre-mRNA. In someembodiments, an antisense of sufficient length includes at least 8, 9,10, 11, 12, 13, 14, or 15 contiguous nucleobases in the targetdystrophin pre-mRNA. In other embodiments an antisense of sufficientlength includes at least 16, 17, 18, 19, 20, 21, 22, 23, 24, or 25contiguous nucleobases in the target dystrophin pre-mRNA. An antisenseoligonucleotide of sufficient length has at least a minimal number ofnucleotides to be capable of specifically hybridizing to exon 44.Preferably an oligonucleotide of sufficient length is from about 10 toabout 50 nucleotides in length, including oligonucleotides of 10, 11,12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,30, 31, 32, 33, 34, 35, 36, 37, 38, 39 and 40 or more nucleotides. Inone embodiment, an oligonucleotide of sufficient length is from 10 toabout 30 nucleotides in length. In another embodiment, anoligonucleotide of sufficient length is from 15 to about 25 nucleotidesin length. In yet another embodiment, an oligonucleotide of sufficientlength is from 20 to 30, or 20 to 50, nucleotides in length. In yetanother embodiment, an oligonucleotide of sufficient length is from 25to 28 nucleotides in length.

By “enhance” or “enhancing,” or “increase” or “increasing,” or“stimulate” or “stimulating,” refers generally to the ability of one orantisense compounds or compositions to produce or cause a greaterphysiological response (i.e., downstream effects) in a cell or asubject, as compared to the response caused by either no antisensecompound or a control compound. A measurable physiological response mayinclude increased expression of a functional form of a dystrophinprotein, or increased dystrophin-related biological activity in muscletissue, among other responses apparent from the understanding in the artand the description herein. Increased muscle function can also bemeasured, including increases or improvements in muscle function byabout 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%,16%, 17%, 18%, 19%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%,70%, 75%, 80%, 85%, 90%, 95%, or 100%. The percentage of muscle fibresthat express a functional dystrophin can also be measured, includingincreased dystrophin expression in about 1%, 2%, %, 15%, 16%, 17%, 18%,19%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%,85%, 90%, 95%, or 100% of muscle fibres. For instance, it has been shownthat around 40% of muscle function improvement can occur if 25-30% offibers express dystrophin (see, e.g., DelloRusso et al, Proc Natl AcadSci USA 99: 12979-12984, 2002). An “increased” or “enhanced” amount istypically a “statistically significant” amount, and may include anincrease that is 1.1, 1.2, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 40,50 or more times (e.g., 500, 1000 times) (including all integers anddecimal points in between and above 1), e.g., 1.5, 1.6, 1.7, 1.8, etc.)the amount produced by no antisense compound (the absence of an agent)or a control compound.

The term “reduce” or “inhibit” may relate generally to the ability ofone or more antisense compounds of the invention to “decrease” arelevant physiological or cellular response, such as a symptom of adisease or condition described herein, as measured according to routinetechniques in the diagnostic art. Relevant physiological or cellularresponses (in vivo or in vitro) will be apparent to persons skilled inthe art, and may include reductions in the symptoms or pathology ofmuscular dystrophy, or reductions in the expression of defective formsof dystrophin, such as the altered forms of dystrophin that areexpressed in individuals with DMD or BMD. A “decrease” in a response maybe statistically significant as compared to the response produced by noantisense compound or a control composition, and may include a 1%, 2%,3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%,19%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%,85%, 90%, 95%, or 100% decrease, including all integers in between.

Also included are vector delivery systems that are capable of expressingthe oligomeric, dystrophin-targeting sequences of the present invention,such as vectors that express a polynucleotide sequence comprising anyone or more of SEQ ID NOs: 1 and 9-13, as described herein. By “vector”or “nucleic acid construct” is meant a polynucleotide molecule,preferably a DNA molecule derived, for example, from a plasmid,bacteriophage, yeast or virus, into which a polynucleotide can beinserted or cloned. A vector preferably contains one or more uniquerestriction sites and can be capable of autonomous replication in adefined host cell including a target cell or tissue or a progenitor cellor tissue thereof, or be integrable with the genome of the defined hostsuch that the cloned sequence is reproducible. Accordingly, the vectorcan be an autonomously replicating vector, i.e., a vector that exists asan extra-chromosomal entity, the replication of which is independent ofchromosomal replication, e.g., a linear or closed circular plasmid, anextra-chromosomal element, a mini-chromosome, or an artificialchromosome. The vector can contain any means for assuringself-replication. Alternatively, the vector can be one which, whenintroduced into the host cell, is integrated into the genome andreplicated together with the chromosome(s) into which it has beenintegrated.

“Treatment” of an individual (e.g. a mammal, such as a human) or a cellis any type of intervention used in an attempt to alter the naturalcourse of the individual or cell. Treatment includes, but is not limitedto, administration of a pharmaceutical composition, and may be performedeither prophylactically or subsequent to the initiation of a pathologicevent or contact with an etiologic agent. Treatment includes anydesirable effect on the symptoms or pathology of a disease or conditionassociated with the dystrophin protein, as in certain forms of musculardystrophy, and may include, for example, minimal changes or improvementsin one or more measurable markers of the disease or condition beingtreated. Also included are “prophylactic” treatments, which can bedirected to reducing the rate of progression of the disease or conditionbeing treated, delaying the onset of that disease or condition, orreducing the severity of its onset. “Treatment” or “prophylaxis” doesnot necessarily indicate complete eradication, cure, or prevention ofthe disease or condition, or associated symptoms thereof.

Hence, included are methods of treating muscular dystrophy, such as DMDand BMD, by administering one or more antisense oligomers of the presentinvention (e.g., SEQ ID NOs: 1 and 6, and variants thereof), optionallyas part of a pharmaceutical formulation or dosage form, to a subject inneed thereof. Also included are methods of inducing exon-skipping in asubject by administering one or more antisense oligomers, in which theexon is exon 44 from the dystrophin gene, preferably the humandystrophin gene. A “subject,” as used herein, includes any animal thatexhibits a symptom, or is at risk for exhibiting a symptom, which can betreated with an antisense compound of the invention, such as a subjectthat has or is at risk for having DMD or BMD, or any of the symptomsassociated with these conditions (e.g., muscle fibre loss). Suitablesubjects (patients) include laboratory animals (such as mouse, rat,rabbit, or guinea pig), farm animals, and domestic animals or pets (suchas a cat or dog). Non-human primates and, preferably, human patients,are included.

“Alkyl” or “alkylene” both refer to a saturated straight or branchedchain hydrocarbon radical containing from 1 to 18 carbons. Examplesinclude without limitation methyl, ethyl, propyl, iso-propyl, butyl,iso-butyl, tert-butyl, n-pentyl and n-hexyl. The term “lower alkyl”refers to an alkyl group, as defined herein, containing between 1 and 8carbons.

“Alkenyl” refers to an unsaturated straight or branched chainhydrocarbon radical containing from 2 to 18 carbons and comprising atleast one carbon to carbon double bond. Examples include withoutlimitation ethenyl, propenyl, iso-propenyl, butenyl, iso-butenyl,tert-butenyl, n-pentenyl and n-hexenyl. The term “lower alkenyl” refersto an alkenyl group, as defined herein, containing between 2 and 8carbons.

“Alkynyl” refers to an unsaturated straight or branched chainhydrocarbon radical containing from 2 to 18 carbons comprising at leastone carbon to carbon triple bond. Examples include without limitationethynyl, propynyl, iso-propynyl, butynyl, iso-butynyl, tert-butynyl,pentynyl and hexynyl. The term “lower alkynyl” refers to an alkynylgroup, as defined herein, containing between 2 and 8 carbons.

“Cycloalkyl” refers to a mono- or poly-cyclic alkyl radical. Examplesinclude without limitation cyclobutyl, cyclopentyl, cyclohexyl,cycloheptyl and cyclooctyl.

“Aryl” refers to a cyclic aromatic hydrocarbon moiety containing from to18 carbons having one or more closed ring(s). Examples include withoutlimitation phenyl, benzyl, naphthyl, anthracenyl, phenanthracenyl andbiphenyl.

“Aralkyl” refers to a radical of the formula RaRb where Ra is analkylene chain as defined above and Rb is one or more aryl radicals asdefined above, for example, benzyl, diphenylmethyl and the like.

“Thioalkoxy” refers to a radical of the formula —SRc where Rc is analkyl radical as defined herein. The term “lower thioalkoxy” refers toan alkoxy group, as defined herein, containing between 1 and 8 carbons.

“Alkoxy” refers to a radical of the formula —ORda where Rd is an alkylradical as defined herein. The term “lower alkoxy” refers to an alkoxygroup, as defined herein, containing between 1 and 8 carbons. Examplesof alkoxy groups include, without limitation, methoxy and ethoxy.

“Alkoxyalkyl” refers to an alkyl group substituted with an alkoxy group.

“Carbonyl” refers to the C(═O)— radical.

“Guanidynyl” refers to the H₂N(C═NH₂)—NH— radical.

“Amidinyl” refers to the H₂N(C═NH₂)CH— radical.

“Amino” refers to the NH₂ radical.

“Alkylamino” refers to a radical of the formula —NHRd or —NRdRd whereeach Rd is, independently, an alkyl radical as defined herein. The term“lower alkylamino” refers to an alkylamino group, as defined herein,containing between 1 and 8 carbons.

“Heterocycle” means a 5- to 7-membered monocyclic, or 7- to 10-memberedbicyclic, heterocyclic ring which is either saturated, unsaturated, oraromatic, and which contains from 1 to 4 heteroatoms independentlyselected from nitrogen, oxygen and sulfur, and wherein the nitrogen andsulfur heteroatoms may be optionally oxidized, and the nitrogenheteroatom may be optionally quaternized, including bicyclic rings inwhich any of the above heterocycles are fused to a benzene ring. Theheterocycle may be attached via any heteroatom or carbon atom.Heterocycles include heteroaryls as defined below. Thus, in addition tothe heteroaryls listed below, heterocycles also include morpholinyl,pyrrolidinonyl, pyrrolidinyl, piperidinyl, piperizinyl, hydantoinyl,valerolactamyl, oxiranyl, oxetanyl, tetrahydrofuranyl,tetrahydropyranyl, tetrahydropyridinyl, tetrahydrothiophenyl,tetrahydrothiopyranyl, tetrahydropyrimidinyl, tetrahydrothiopyranyl, andthe like.

“Heteroaryl” means an aromatic heterocycle ring of 5- to 10 members andhaving at least one heteroatom selected from nitrogen, oxygen andsulfur, and containing at least 1 carbon atom, including both mono- andbicyclic ring systems. Representative heteroaryls are pyridyl, furyl,benzofuranyl, thiophenyl, benzothiophenyl, quinolinyl, pyrrolyl,indolyl, oxazolyl, benzoxazolyl, imidazolyl, benzimidazolyl, thiazolyl,benzothiazolyl, isoxazolyl, pyrazolyl, isothiazolyl, pyridazinyl,pyrimidinyl, pyrazinyl, triazinyl, cinnolinyl, phthalazinyl, andquinazolinyl.

The terms “optionally substituted alkyl”, “optionally substitutedalkenyl”, “optionally substituted alkoxy”, “optionally substitutedthioalkoxy”, “optionally substituted alkyl amino”, “optionallysubstituted lower alkyl”, “optionally substituted lower alkenyl”,“optionally substituted lower alkoxy”, “optionally substituted lowerthioalkoxy”, “optionally substituted lower alkyl amino” and “optionallysubstituted heterocyclyl” mean that, when substituted, at least onehydrogen atom is replaced with a substituent. In the case of an oxosubstituent (═O) two hydrogen atoms are replaced. In this regard,substituents include: deuterium, optionally substituted alkyl,optionally substituted alkenyl, optionally substituted alkynyl,optionally substituted aryl, optionally substituted heterocycle,optionally substituted cycloalkyl, oxo, halogen, —CN, —ORx, NRxRy,NRxC(═O)Ry, NRxSO2Ry, —NRxC(═O)NRxRy, C(═O)Rx, C(═O)ORx, C(═O)NRxRy,—SOmRx and —SOmNRxRy, wherein m is 0, 1 or 2, Rx and Ry are the same ordifferent and independently hydrogen, optionally substituted alkyl,optionally substituted alkenyl, optionally substituted alkynyl,optionally substituted aryl, optionally substituted heterocycle oroptionally substituted cycloalkyl and each of said optionallysubstituted alkyl, optionally substituted alkenyl, optionallysubstituted alkynyl, optionally substituted aryl, optionally substitutedheterocycle and optionally substituted cycloalkyl substituents may befurther substituted with one or more of oxo, halogen, —CN, —ORx, NRxRy,NRxC(═O)Ry, NRxSO2Ry, —NRxC(═O)NRxRy, C(═O)Rx, C(═O)ORx, C(═O)NRxRy,—SOmRx and —SOmNRxRy.

An antisense molecule nomenclature system was proposed and published todistinguish between the different antisense molecules (see Mann et al.,(2002) J Gen Med 4, 644-654). This nomenclature became especiallyrelevant when testing several slightly different antisense molecules,all directed at the same target region, as shown below:

H#A/D(x:y).

The first letter designates the species (e.g. H: human, M: murine, C:canine). “#” designates target dystrophin exon number. “A/D” indicatesacceptor or donor splice site at the beginning and end of the exon,respectively. (x y) represents the annealing coordinates where “−” or“+” indicate intronic or exonic sequences respectively. For example,A(−6+18) would indicate the last 6 bases of the intron preceding thetarget exon and the first 18 bases of the target exon. The closestsplice site would be the acceptor so these coordinates would be precededwith an “A”. Describing annealing coordinates at the donor splice sitecould be D(+2−18) where the last 2 exonic bases and the first 18intronic bases correspond to the annealing site of the antisensemolecule. Entirely exonic annealing coordinates that would berepresented by A(+65+85), that is the site between the 65th and 85thnucleotide from the start of that exon.

II. CONSTRUCTING THE ANTISENSE OLIGONUCLEOTIDE

Exemplary embodiments of the invention relate to morpholinooligonucleotides having phosphorus-containing backbone linkages areillustrated in FIGS. 1A-1C. Preferred is a phosphorodiamidate-linkedmorpholino oligonucleotide such as shown in FIG. 1C, which is modified,in accordance with one aspect of the present invention, to containpositively charged groups at preferably 10%-50% of its backbonelinkages. Morpholino oligonucleotides with uncharged backbone linkages,including antisense oligonucleotides, are detailed, for example, in(Summerton and Weller 1997) and in co-owned U.S. Pat. Nos. 5,698,685,5,217,866, 5,142,047, 5,034,506, 5,166,315, 5,185, 444, 5,521,063,5,506,337, 8,076,476, 8,299,206 and 7,943,762 all of which are expresslyincorporated by reference herein.

Important properties of the morpholino-based subunits include: 1) theability to be linked in a oligomeric form by stable, uncharged orpositively charged backbone linkages; 2) the ability to support anucleotide base (e.g. adenine, cytosine, guanine, thymidine, uracil andinosine) such that the polymer formed can hybridize with acomplementary-base target nucleic acid, including target RNA, Tm valuesabove about 45° C. in relatively short oligonucleotides (e.g., 10-15bases); 3) the ability of the oligonucleotide to be actively orpassively transported into mammalian cells; and 4) the ability of theantisense oligonucleotide:RNA heteroduplex to resist RNAse and RNase Hdegradation, respectively.

Exemplary backbone structures for antisense oligonucleotides of theclaimed subject matter include the morpholino subunit types shown inFIGS. 1D-G, each linked by an uncharged or positively charged,phosphorus-containing subunit linkage. FIG. 1D shows aphosphorus-containing linkage which forms the five atom repeating-unitbackbone, where the morpholino rings are linked by a 1-atom phosphoamidelinkage. FIG. 1E shows a linkage which produces a 6-atom repeating-unitbackbone. In this structure, the atom Y linking the 5′ morpholino carbonto the phosphorus group may be sulfur, nitrogen, carbon or, preferably,oxygen. The X moiety pendant from the phosphorus may be fluorine, analkyl or substituted alkyl, an alkoxy or substituted alkoxy, athioalkoxy or substituted thioalkoxy, or unsubstituted, monosubstituted,or disubstituted nitrogen, including cyclic structures, such asmorpholines or piperidines. Alkyl, alkoxy and thioalkoxy preferablyinclude 1-6 carbon atoms. The Z moieties are sulfur or oxygen, and arepreferably oxygen.

The linkages shown in FIGS. 1F and 1G are designed for 7-atomunit-length backbones. In structure 1F, the X moiety is as in Structure1E, and the Y moiety may be methylene, sulfur, or, preferably, oxygen.In Structure 1G, the X and Y moieties are as in Structure 1E.Particularly preferred morpholino oligonucleotides include thosecomposed of morpholino subunit structures of the form shown in FIG. 1E,where X=NH₂, N(CH₃)₂, or 1-piperazine or other charged group, Y=O, andZ=O.

A substantially uncharged oligonucleotide may be modified, in accordancewith an aspect of the invention, to include charged linkages, e.g., upto about 1 per every 2-5 uncharged linkages, such as about 4-5 per every10 uncharged linkages. In certain embodiments, optimal improvement inantisense activity may be seen when about 25% of the backbone linkagesare cationic. In certain embodiments, enhancement may be seen with asmall number e.g., 10-20% cationic linkages, or where the number ofcationic linkages are in the range 50-80%, such as about 60%.

Oligomers having any number of cationic linkages are provided, includingfully cationic-linked oligomers. Preferably, however, the oligomers arepartially charged, having, for example, 10%-80%. In preferredembodiments, about 10% to 60%, and preferably 20% to 50% of the linkagesare cationic.

In one embodiment, the cationic linkages are interspersed along thebackbone. The partially charged oligomers preferably contain at leasttwo consecutive uncharged linkages; that is, the oligomer preferablydoes not have a strictly alternating pattern along its entire length.

Also considered are oligomers having blocks of cationic linkages andblocks of uncharged linkages; for example, a central block of unchargedlinkages may be flanked by blocks of cationic linkages, or vice versa.In one embodiment, the oligomer has approximately equal-length 5′, 3′and center regions, and the percentage of cationic linkages in thecenter region is greater than about 50%, preferably greater than about70%.

In certain embodiments, the antisense compounds can be prepared bystepwise solid-phase synthesis, employing methods detailed in thereferences cited above, and below with respect to the synthesis ofoligonucleotides having a mixture or uncharged and cationic backbonelinkages. In some cases, it may be desirable to add additional chemicalmoieties to the antisense compound, e.g., to enhance pharmacokinetics orto facilitate capture or detection of the compound. Such a moiety may becovalently attached, according to standard synthetic methods. Forexample, addition of a polyethylene glycol moiety or other hydrophilicpolymer, e.g., one having 1-100 monomeric subunits, may be useful inenhancing solubility.

A reporter moiety, such as fluorescein or a radiolabeled group, may beattached for purposes of detection. Alternatively, the reporter labelattached to the oligomer may be a ligand, such as an antigen or biotin,capable of binding a labeled antibody or streptavidin. In selecting amoiety for attachment or modification of an antisense compound, it isgenerally of course desirable to select chemical compounds of groupsthat are biocompatible and likely to be tolerated by a subject withoutundesirable side effects.

Oligomers for use in antisense applications generally range in lengthfrom about 10 to about 50 subunits, more preferably about 10 to 30subunits, and typically 15-25 bases. For example, an oligomer of theinvention having 19-20 subunits, a useful length for an antisensecompound, may ideally have two to ten, e.g., four to eight, cationiclinkages, and the remainder uncharged linkages. An oligomer having 14-15subunits may ideally have two to seven, e.g., 3, 4, or 5, cationiclinkages and the remainder uncharged linkages. In a preferredembodiment, the oligomers have 25 to 28 subunits.

Each morpholino ring structure supports a base pairing moiety, to form asequence of base pairing moieties which is typically designed tohybridize to a selected antisense target in a cell or in a subject beingtreated. The base pairing moiety may be a purine or pyrimidine found innative DNA or RNA (e.g., A, G, C, T or U) or an analog, such ashypoxanthine (the base component of the nucleoside inosine) or 5-methylcytosine.

As noted above, certain embodiments are directed to oligomers comprisingnovel intersubunit linkages, including PMO-X oligomers and those havingmodified terminal groups. In some embodiments, these oligomers havehigher affinity for DNA and RNA than do the corresponding unmodifiedoligomers and demonstrate improved cell delivery, potency, and/or tissuedistribution properties compared to oligomers having other intersubunitlinkages. The structural features and properties of the various linkagetypes and oligomers are described in more detail in the followingdiscussion. The synthesis of these and related oligomers is described inco-owned U.S. application Ser. No. 13/118,298, which is incorporated byreference in its entirety.

In certain embodiments, the invention provides for an oligonucleotidehaving a sequence complementary to the target sequence which isassociated with a human disease, and comprises a sequence of nucleotideshaving a formula:

-   -   wherein Nu is a nucleobase;    -   R₁ has the formula

-   -   q is 0, 1, or 2;

R₂ is selected from the group consisting of hydrogen, C₁-C₅ alkyl, C₁-C₅aralkyl, and a formamidinyl group, and

R₃ is selected from the group consisting of hydrogen, C₁-C₁₀ acyl,C₁-C₁₀ aminoacyl, acyl moiety of a natural or unnatural alpha or betaamino acid, C₁-C₁₀ aralkyl, and C₁-C₁₀ alkyl, or

R₂ and R₃ are joined to form a 5-7 membered ring where the ring may beoptionally substituted with a substituent selected from the groupconsisting of C₁-C₁₀ alkyl, phenyl, halogen, and C₁-C₁₀ aralkyl;

R₄ is selected from the group consisting of an electron pair, hydrogen,a C₁-C₆ alkyl and C₁-C₆ aralkyl;

Rx is selected from the group consisting of sarcosinamide, hydroxyl, anucleotide, a cell penetrating peptide moiety, and piperazinyl;

Ry is selected from the group consisting of hydrogen, a C₁-C₆ alkyl, anucleotide a cell penetrating peptide moiety, an amino acid, aformamidinyl group, and C₁-C₆ acyl; and,

Rz is selected from the group consisting of an electron pair, hydrogen,a C₁-C₆ alkyl, and C₁-C₆ acyl pharmaceutically acceptable salts thereof.

Nu may be selected from the group consisting of adenine, guanine,thymine, uracil, cytosine, and hypoxanthine. More preferably Nu isthymine or uracil.

In preferred embodiments, the invention provides an oligonucleotidehaving a sequence of nucleotides having a formula:

-   -   wherein Nu is a nucleobase;    -   R₁ is selected from the group consisting of R₁′ and R₁″ wherein        R₁′ is dimethyl-amino and R₁″ has the formula

wherein at least one R₁ is R₁″;

q is 0, 1, or 2; with the proviso that at least one of R₁ is apiperidinyl moiety;

R₂ is selected from the group consisting of hydrogen, C₁-C₅ alkyl, C₁-C₅aralkyl, and a formamidinyl group, and

R₃ is selected from the group consisting of hydrogen, C₁-C₁₀ acyl,C₁-C₁₀ aminoacyl, acyl moiety of a natural or unnatural alpha or betaamino acid, C₁-C₁₀ aralkyl, and C₁-C₁₀ alkyl, or

R₂ and R₃ are joined to form a 5-7 membered ring where the ring may beoptionally substituted with a substituent selected from the groupconsisting of C₁-C₁₀ alkyl, phenyl, halogen, and C₁-C₁₀ aralkyl;

R₄ is selected from the group consisting of an electron pair, hydrogen,a C₁-C₆ alkyl and aralkyl;

Rx is selected from the group consisting of sarcosinamide, hydroxyl, anucleotide, a cell penetrating peptide moiety, and piperazinyl;

Ry is selected from the group consisting of hydrogen, a C₁-C₆ alkyl, anucleotide a cell penetrating peptide moiety, an amino acid, aformamidinyl group, and C₁-C₆ acyl; and,

Rz is selected from the group consisting of an electron pair, hydrogen,a C₁-C₆ alkyl, and C₁-C₆ acyl pharmaceutically acceptable salts thereof.

Nu may be selected from the group consisting of adenine, guanine,thymine, uracil, cytosine, and hypoxanthine. More preferably Nu isthymine or uracil.

About 90-50% of the R₁ groups are dimethylamino (i.e. R₁′). More,preferably, 90-50% of the R₁ groups are dimethylamino. Most, preferablyabout 66% of the R₁ groups are dimethylamino.

R₁″ may be selected from the group consisting of

Preferably, at least one nucleotide of the oligonucleotide has theformula:

wherein Rx, Ry, Rz, and Nu are as stated above. Most preferably, Nu isthymine or uracil.

Although thymine (T) is the preferred base pairing moiety (Nu or Pi)containing the chemical modifications described above, any base subunitknown to a person of skill in the art can be used as the base pairingmoiety.

The oligonucleotide and the DNA or RNA are complementary to each otherwhen a sufficient number of corresponding positions in each molecule areoccupied by nucleotides which can hydrogen bond with each other. Thus,“specifically hybridizable” and “complementary” are terms which are usedto indicate a sufficient degree of complementarity or precise pairingsuch that stable and specific binding occurs between the oligonucleotideand the DNA or RNA target. It is understood in the art that the sequenceof an antisense molecule need not be 100% complementary to that of itstarget sequence to be specifically hybridizable. An antisense moleculeis specifically hybridizable when binding of the compound to the targetDNA or RNA molecule interferes with the normal function of the targetDNA or RNA to cause a loss of utility, and there is a sufficient degreeof complementarity to avoid non-specific binding of the antisensecompound to non-target sequences under conditions in which specificbinding is desired, i.e., under physiological conditions in the case ofin vivo assays or therapeutic treatment, and in the case of in vitroassays, under conditions in which the assays are performed.

While the above method may be used to select antisense molecules capableof deleting any exon from within a protein that is capable of beingshortened without affecting its biological function, the exon deletionshould not lead to a reading frame shift in the shortened transcribedmRNA. Thus, if in a linear sequence of three exons the end of the firstexon encodes two of three nucleotides in a codon and the next exon isdeleted then the third exon in the linear sequence must start with asingle nucleotide that is capable of completing the nucleotide tripletfor a codon. If the third exon does not commence with a singlenucleotide there will be a reading frame shift that would lead to thegeneration of truncated or a non-functional protein.

It will be appreciated that the codon arrangements at the end of exonsin structural proteins may not always break at the end of a codon,consequently there may be a need to delete more than one exon from thepre-mRNA to ensure in-frame reading of the mRNA. In such circumstances,a plurality of antisense oligonucleotides may need to be selected by themethod of the invention wherein each is directed to a different regionresponsible for inducing splicing in the exons that are to be deleted.

The length of an antisense molecule may vary so long as it is capable ofbinding selectively to the intended location within the pre-mRNAmolecule. The length of such sequences can be determined in accordancewith selection procedures described herein. Generally, the antisensemolecule will be from about 10 nucleotides in length up to about 50nucleotides in length. It will be appreciated however that any length ofnucleotides within this range may be used in the method. Preferably, thelength of the antisense molecule is between 10-30 nucleotides in length.

The most common method for producing antisense molecules is themethylation of the 2′ hydroxyribose position and the incorporation of aphosphorothioate backbone produces molecules that superficially resembleRNA but that are much more resistant to nuclease degradation.

To avoid degradation of pre-mRNA during duplex formation with theantisense molecules, the antisense molecules used in the method may beadapted to minimize or prevent cleavage by endogenous RNase H. Thisproperty is highly preferred as the treatment of the RNA with theunmethylated oligonucleotides either intracellularly or in crudeextracts that contain RNase H leads to degradation of the pre-mRNA:antisense oligonucleotide duplexes. Any form of modified antisensemolecules that is capable of by-passing or not inducing such degradationmay be used in the present method. An example of antisense moleculeswhich when duplexed with RNA are not cleaved by cellular RNase H is2′-O-methyl derivatives. 2′-O-methyl-oligoribonucleotides are verystable in a cellular environment and in animal tissues, and theirduplexes with RNA have higher Tm values than their ribo- ordeoxyribo-counterparts.

Antisense molecules that do not activate RNase H can be made inaccordance with known techniques (see, e.g., U.S. Pat. No. 5,149,797).Such antisense molecules, which may be deoxyribonucleotide orribonucleotide sequences, simply contain any structural modificationwhich sterically hinders or prevents binding of RNase H to a duplexmolecule containing the oligonucleotide as one member thereof, whichstructural modification does not substantially hinder or disrupt duplexformation. Because the portions of the oligonucleotide involved induplex formation are substantially different from those portionsinvolved in RNase H binding thereto, numerous antisense molecules thatdo not activate RNase H are available. For example, such antisensemolecules may be oligonucleotides wherein at least one, or all, of theinter-nucleotide bridging phosphate residues are modified phosphates,such as methyl phosphonates, methyl phosphorothioates,phosphoromorpholidates, phosphoropiperazidates and phosphoramidates. Forexample, every other one of the internucleotide bridging phosphateresidues may be modified as described. In another non-limiting example,such antisense molecules are molecules wherein at least one, or all, ofthe nucleotides contain a 2′ lower alkyl moiety (e.g., C₁-C₄, linear orbranched, saturated or unsaturated alkyl, such as methyl, ethyl,ethenyl, propyl, 1-propenyl, 2-propenyl, and isopropyl). For example,every other one of the nucleotides may be modified as described.

While antisense oligonucleotides are a preferred form of the antisensemolecules, the present invention comprehends other oligomeric antisensemolecules, including but not limited to oligonucleotide mimetics such asare described below.

Specific examples of preferred antisense compounds useful in thisinvention include oligonucleotides containing modified backbones ornon-natural inter-nucleoside linkages. As defined in this specification,oligonucleotides having modified backbones include those that retain aphosphorus atom in the backbone and those that do not have a phosphorusatom in the backbone. For the purposes of this specification, and assometimes referenced in the art, modified oligonucleotides that do nothave a phosphorus atom in their inter-nucleoside backbone can also beconsidered to be oligonucleosides.

In other preferred oligonucleotide mimetics, both the sugar and theinter-nucleoside linkage, i.e., the backbone, of the nucleotide unitsare replaced with novel groups. The base units are maintained forhybridization with an appropriate nucleic acid target compound. One sucholigomeric compound, an oligonucleotide mimetic that has been shown tohave excellent hybridization properties, is referred to as a peptidenucleic acid (PNA). In PNA compounds, the sugar-backbone of anoligonucleotide is replaced with an amide containing backbone, inparticular an aminoethylglycine backbone. The nucleo-bases are retainedand are bound directly or indirectly to aza nitrogen atoms of the amideportion of the backbone.

Modified oligonucleotides may also contain one or more substituted sugarmoieties. Oligonucleotides may also include nucleobase (often referredto in the art simply as “base”) modifications or substitutions. Certainnucleo-bases are particularly useful for increasing the binding affinityof the oligomeric compounds of the invention. These include5-substituted pyrimidines, 6-azapyrimidines and N-2, N-6 and O-6substituted purines, including 2-aminopropyladenine, 5-propynyluraciland 5-propynylcytosine. 5-methylcytosine substitutions have been shownto increase nucleic acid duplex stability by 0.6-1.2° C. and arepresently preferred base substitutions, even more particularly whencombined with 2′-O-methoxyethyl sugar modifications.

Another modification of the oligonucleotides of the invention involveschemically linking to the oligonucleotide one or more moieties orconjugates that enhance the activity, cellular distribution or cellularuptake of the oligonucleotide. Such moieties include but are not limitedto lipid moieties such as a cholesterol moiety, cholic acid, athioether, e.g., hexyl-5-tritylthiol, a thiocholesterol, an aliphaticchain, e.g., dodecandiol or undecyl residues, a phospholipid, e.g.,di-hexadecyl-rac-glycerol or triethylammonium1,2-di-O-hexadecyl-rac-glycero-3-H-phosphonate, a polyamine or apolyethylene glycol chain, or adamantane acetic acid, a palmityl moiety,or an octadecylamine or hexylamino-carbonyl-oxycholesterol moiety.

It is not necessary for all positions in a given compound to beuniformly modified, and in fact more than one of the aforementionedmodifications may be incorporated in a single compound or even at asingle nucleoside within an oligonucleotide. The present invention alsoincludes antisense compounds that are chimeric compounds. “Chimeric”antisense compounds or “chimeras,” in the context of this invention, areantisense molecules, particularly oligonucleotides, which contain two ormore chemically distinct regions, each made up of at least one monomerunit, i.e., a nucleotide in the case of an oligonucleotide compound.These oligonucleotides typically contain at least one region wherein theoligonucleotide is modified so as to confer upon the increasedresistance to nuclease degradation, increased cellular uptake, and anadditional region for increased binding affinity for the target nucleicacid.

III. PEPTIDE TRANSPORTERS

The antisense compounds of the invention may include an oligonucleotidemoiety conjugated to a CPP, preferably an arginine-rich peptidetransport moiety effective to enhance transport of the compound intocells. The transport moiety is preferably attached to a terminus of theoligomer, as shown, for example, in FIGS. 1B and 1C. The peptides havethe capability of inducing cell penetration within 30%, 40%, 50%, 60%,70%, 80%, 90% or 100% of cells of a given cell culture population,including all integers in between, and allow macromoleculartranslocation within multiple tissues in vivo upon systemicadministration. In one embodiment, the cell-penetrating peptide may bean arginine-rich peptide transporter. In another embodiment, thecell-penetrating peptide may be Penetratin or the Tat peptide. Thesepeptides are well known in the art and are disclosed, for example, in USPublication No. 2010-0016215 A1, incorporated by reference in itsentirety. A particularly preferred approach to conjugation of peptidesto antisense oligonucleotides can be found in PCT publicationWO2012/150960, which is incorporated by reference in its entirety. Apreferred embodiment of a peptide conjugated oligonucleotide of thepresent invention utilizes glycine as the linker between the CPP and theantisense oligonucleotide. For example, a preferred peptide conjugatedPMO consists of R₆-G-PMO.

The transport moieties as described above have been shown to greatlyenhance cell entry of attached oligomers, relative to uptake of theoligomer in the absence of the attached transport moiety. Uptake ispreferably enhanced at least ten fold, and more preferably twenty fold,relative to the unconjugated compound.

The use of arginine-rich peptide transporters (i.e., cell-penetratingpeptides) are particularly useful in practicing the present invention.Certain peptide transporters have been shown to be highly effective atdelivery of antisense compounds into primary cells including musclecells (Marshall, Oda et al. 2007; Jearawiriyapaisarn, Moulton et al.2008; Wu, Moulton et al. 2008). Furthermore, compared to other knownpeptide transporters such as Penetratin and the Tat peptide, the peptidetransporters described herein, when conjugated to an antisense PMO,demonstrate an enhanced ability to alter splicing of several genetranscripts (Marshall, Oda et al. 2007).

Exemplary peptide transporters, excluding linkers are given below inTable 1.

TABLE 1 Exemplary peptide transporters NAME SEQ (DESIGNATION) SEQUENCEID NO^(A) rTAT RRRQRRKKR 19 Tat RKKRRQRRR 20 R₉F₂ RRRRRRRRRFF 21 R₅F₂R₄RRRRRFFRRRR 22 R₄ RRRR 23 R₅ RRRRR 24 R₆ RRRRRR 25 R₇ RRRRRRR 26 R₈RRRRRRRR 27 R₉ RRRRRRRRR 28 (RX)₈ RXRXRXRXRXRXRXRX 29 (RAhxR)₄;RAhxRRAhxRRAhxRRAhxR 30 (P007) (RAhxR)₅; RAhxRRAhxRRAhxRRAhxRRAhxR 31(CP04057) (RAhxRRBR)₂; RAhxRRBRRAhxRRBR 32 (CP06062) (RAR)₄F₂RARRARRARRARFF 33 (RGR)₄F₂ RGRRGRRGRRGRFF 34 ^(A)Sequences assigned toSEQ ID NOs do not include the linkage portion (e.g., C, G, P, Ahx, B,AhxB where Ahx and B refer to 6-aminohexanoic acid and beta-alanine,respectively).

IV. FORMULATIONS

In certain embodiments, the present invention provides formulations orcompositions suitable for the therapeutic delivery of antisenseoligomers, as described herein. Hence, in certain embodiments, thepresent invention provides pharmaceutically acceptable compositions thatcomprise a therapeutically-effective amount of one or more of theoligomers described herein, formulated together with one or morepharmaceutically acceptable carriers (additives) and/or diluents. Whileit is possible for an oligomer of the present invention to beadministered alone, it is preferable to administer the compound as apharmaceutical formulation (composition).

Methods for the delivery of nucleic acid molecules are described, forexample, in Akhtar et al., 1992, Trends Cell Bio., 2:139; and DeliveryStrategies for Antisense Oligonucleotide Therapeutics, ed. Akhtar;Sullivan et al., PCT WO 94/02595. These and other protocols can beutilized for the delivery of virtually any nucleic acid molecule,including the isolated oligomers of the present invention.

As detailed below, the pharmaceutical compositions of the presentinvention may be specially formulated for administration in solid orliquid form, including those adapted for the following: (1) oraladministration, for example, drenches (aqueous or non-aqueous solutionsor suspensions), tablets, e.g., those targeted for buccal, sublingual,and systemic absorption, boluses, powders, granules, pastes forapplication to the tongue; (2) parenteral administration, for example,by subcutaneous, intramuscular, intravenous or epidural injection as,for example, a sterile solution or suspension, or sustained-releaseformulation; (3) topical application, for example, as a cream, ointment,or a controlled-release patch or spray applied to the skin; (4)intravaginally or intrarectally, for example, as a pessary, cream orfoam; (5) sublingually; (6) ocularly; (7) transdermally; or (8) nasally.

The phrase “pharmaceutically acceptable” is employed herein to refer tothose compounds, materials, compositions, and/or dosage forms which are,within the scope of sound medical judgment, suitable for use in contactwith the tissues of human beings and animals without excessive toxicity,irritation, allergic response, or other problem or complication,commensurate with a reasonable benefit/risk ratio.

The phrase “pharmaceutically-acceptable carrier” as used herein means apharmaceutically-acceptable material, composition or vehicle, such as aliquid or solid filler, diluent, excipient, manufacturing aid (e.g.,lubricant, talc magnesium, calcium or zinc stearate, or steric acid), orsolvent encapsulating material, involved in carrying or transporting thesubject compound from one organ, or portion of the body, to anotherorgan, or portion of the body. Each carrier must be “acceptable” in thesense of being compatible with the other ingredients of the formulationand not injurious to the patient.

Some examples of materials that can serve as pharmaceutically-acceptablecarriers include, without limitation: (1) sugars, such as lactose,glucose and sucrose; (2) starches, such as corn starch and potatostarch; (3) cellulose, and its derivatives, such as sodium carboxymethylcellulose, ethyl cellulose and cellulose acetate; (4) powderedtragacanth; (5) malt; (6) gelatin; (7) talc; (8) excipients, such ascocoa butter and suppository waxes; (9) oils, such as peanut oil,cottonseed oil, safflower oil, sesame oil, olive oil, corn oil andsoybean oil; (10) glycols, such as propylene glycol; (11) polyols, suchas glycerin, sorbitol, mannitol and polyethylene glycol; (12) esters,such as ethyl oleate and ethyl laurate; (13) agar; (14) bufferingagents, such as magnesium hydroxide and aluminum hydroxide; (15) alginicacid; (16) pyrogen-free water; (17) isotonic saline; (18) Ringer'ssolution; (19) ethyl alcohol; (20) pH buffered solutions; (21)polyesters, polycarbonates and/or polyanhydrides; and (22) othernon-toxic compatible substances employed in pharmaceutical formulations.

Additional non-limiting examples of agents suitable for formulation withthe antisense oligomers of the instant invention include: PEG conjugatednucleic acids, phospholipid conjugated nucleic acids, nucleic acidscontaining lipophilic moieties, phosphorothioates, P-glycoproteininhibitors (such as Pluronic P85) which can enhance entry of drugs intovarious tissues; biodegradable polymers, such as poly(DL-lactide-coglycolide) microspheres for sustained release deliveryafter implantation (Emerich, D F et al., 1999, Cell Transplant, 8,47-58) Alkermes, Inc. Cambridge, Mass.; and loaded nanoparticles, suchas those made of polybutylcyanoacrylate, which can deliver drugs acrossthe blood brain barrier and can alter neuronal uptake mechanisms (ProgNeuropsychopharmacol Biol Psychiatry, 23, 941-949, 1999).

The invention also features the use of the composition comprisingsurface-modified liposomes containing poly (ethylene glycol) lipids(PEG-modified, branched and unbranched or combinations thereof, orlong-circulating liposomes or stealth liposomes). Oligomers of theinvention can also comprise covalently attached PEG molecules of variousmolecular weights. These formulations offer a method for increasing theaccumulation of drugs in target tissues. This class of drug carriersresists opsonization and elimination by the mononuclear phagocyticsystem (MPS or RES), thereby enabling longer blood circulation times andenhanced tissue exposure for the encapsulated drug (Lasic et al. Chem.Rev. 1995, 95, 2601-2627; Ishiwata et al., Chem. Pharm. Bull. 1995, 43,1005-1011). Such liposomes have been shown to accumulate selectively intumors, presumably by extravasation and capture in the neovascularizedtarget tissues (Lasic et al., Science 1995, 267, 1275-1276; Oku et al.,1995, Biochim. Biophys. Acta, 1238, 86-90). The long-circulatingliposomes enhance the pharmacokinetics and pharmacodynamics of DNA andRNA, particularly compared to conventional cationic liposomes which areknown to accumulate in tissues of the MPS (Liu et al., J. Biol. Chem.1995, 42, 24864-24870; Choi et al., International PCT Publication No. WO96/10391; Ansell et al., International PCT Publication No. WO 96/10390;Holland et al., International PCT Publication No. WO 96/10392).Long-circulating liposomes are also likely to protect drugs fromnuclease degradation to a greater extent compared to cationic liposomes,based on their ability to avoid accumulation in metabolically aggressiveMPS tissues such as the liver and spleen.

In a further embodiment, the present invention includes oligomercompositions prepared for delivery as described in U.S. Pat. Nos.6,692,911, 7,163,695 and 7,070,807. In this regard, in one embodiment,the present invention provides an oligomer of the present invention in acomposition comprising copolymers of lysine and histidine (HK) (asdescribed in U.S. Pat. Nos. 7,163,695, 7,070,807, and 6,692,911) eitheralone or in combination with PEG (e.g., branched or unbranched PEG or amixture of both), in combination with PEG and a targeting moiety or anyof the foregoing in combination with a crosslinking agent. In certainembodiments, the present invention provides antisense oligomers incompositions comprising gluconic-acid-modified polyhistidine orgluconylated-polyhistidine/transferrin-polylysine. One skilled in theart will also recognize that amino acids with properties similar to Hisand Lys may be substituted within the composition.

Certain embodiments of the oligomers described herein may contain abasic functional group, such as amino or alkylamino, and are, thus,capable of forming pharmaceutically-acceptable salts withpharmaceutically-acceptable acids. The term “pharmaceutically-acceptablesalts” in this respect, refers to the relatively non-toxic, inorganicand organic acid addition salts of compounds of the present invention.These salts can be prepared in situ in the administration vehicle or thedosage form manufacturing process, or by separately reacting a purifiedcompound of the invention in its free base form with a suitable organicor inorganic acid, and isolating the salt thus formed during subsequentpurification. Representative salts include the hydrobromide,hydrochloride, sulfate, bisulfate, phosphate, nitrate, acetate,valerate, oleate, palmitate, stearate, laurate, benzoate, lactate,phosphate, tosylate, citrate, maleate, fumarate, succinate, tartrate,napthylate, mesylate, glucoheptonate, lactobionate, and laurylsulphonatesalts and the like. (See, e.g., Berge et al. (1977) “PharmaceuticalSalts”, J. Pharm. Sci. 66:1-19).

The pharmaceutically acceptable salts of the subject oligomers includethe conventional nontoxic salts or quaternary ammonium salts of thecompounds, e.g., from non-toxic organic or inorganic acids. For example,such conventional nontoxic salts include those derived from inorganicacids such as hydrochloride, hydrobromic, sulfuric, sulfamic,phosphoric, nitric, and the like; and the salts prepared from organicacids such as acetic, propionic, succinic, glycolic, stearic, lactic,malic, tartaric, citric, ascorbic, palmitic, maleic, hydroxymaleic,phenylacetic, glutamic, benzoic, salicyclic, sulfanilic,2-acetoxybenzoic, fumaric, toluenesulfonic, methanesulfonic, ethanedisulfonic, oxalic, isothionic, and the like.

In certain embodiments, the oligomers of the present invention maycontain one or more acidic functional groups and, thus, are capable offorming pharmaceutically-acceptable salts withpharmaceutically-acceptable bases. The term “pharmaceutically-acceptablesalts” in these instances refers to the relatively non-toxic, inorganicand organic base addition salts of compounds of the present invention.These salts can likewise be prepared in situ in the administrationvehicle or the dosage form manufacturing process, or by separatelyreacting the purified compound in its free acid form with a suitablebase, such as the hydroxide, carbonate or bicarbonate of apharmaceutically-acceptable metal cation, with ammonia, or with apharmaceutically-acceptable organic primary, secondary or tertiaryamine. Representative alkali or alkaline earth salts include thelithium, sodium, potassium, calcium, magnesium, and aluminum salts andthe like. Representative organic amines useful for the formation of baseaddition salts include ethylamine, diethylamine, ethylenediamine,ethanolamine, diethanolamine, piperazine and the like. (See, e.g., Bergeet al., supra).

Wetting agents, emulsifiers and lubricants, such as sodium laurylsulfate and magnesium stearate, as well as coloring agents, releaseagents, coating agents, sweetening, flavoring and perfuming agents,preservatives and antioxidants can also be present in the compositions.

Examples of pharmaceutically-acceptable antioxidants include: (1) watersoluble antioxidants, such as ascorbic acid, cysteine hydrochloride,sodium bisulfate, sodium metabisulfite, sodium sulfite and the like; (2)oil-soluble antioxidants, such as ascorbyl palmitate, butylatedhydroxyanisole (BHA), butylated hydroxytoluene (BHT), lecithin, propylgallate, alpha-tocopherol, and the like; and (3) metal chelating agents,such as citric acid, ethylenediamine tetraacetic acid (EDTA), sorbitol,tartaric acid, phosphoric acid, and the like.

Formulations of the present invention include those suitable for oral,nasal, topical (including buccal and sublingual), rectal, vaginal and/orparenteral administration. The formulations may conveniently bepresented in unit dosage form and may be prepared by any methods wellknown in the art of pharmacy. The amount of active ingredient that canbe combined with a carrier material to produce a single dosage form willvary depending upon the host being treated, the particular mode ofadministration. The amount of active ingredient which can be combinedwith a carrier material to produce a single dosage form will generallybe that amount of the compound which produces a therapeutic effect.Generally, out of one hundred percent, this amount will range from about0.1 percent to about ninety-nine percent of active ingredient,preferably from about 5 percent to about 70 percent, most preferablyfrom about 10 percent to about 30 percent.

In certain embodiments, a formulation of the present invention comprisesan excipient selected from cyclodextrins, celluloses, liposomes, micelleforming agents, e.g., bile acids, and polymeric carriers, e.g.,polyesters and polyanhydrides; and an oligomer of the present invention.In certain embodiments, an aforementioned formulation renders orallybioavailable an oligomer of the present invention.

Methods of preparing these formulations or compositions include the stepof bringing into association an oligomer of the present invention withthe carrier and, optionally, one or more accessory ingredients. Ingeneral, the formulations are prepared by uniformly and intimatelybringing into association a compound of the present invention withliquid carriers, or finely divided solid carriers, or both, and then, ifnecessary, shaping the product.

Formulations of the invention suitable for oral administration may be inthe form of capsules, cachets, pills, tablets, lozenges (using aflavored basis, usually sucrose and acacia or tragacanth), powders,granules, or as a solution or a suspension in an aqueous or non-aqueousliquid, or as an oil-in-water or water-in-oil liquid emulsion, or as anelixir or syrup, or as pastilles (using an inert base, such as gelatinand glycerin, or sucrose and acacia) and/or as mouth washes and thelike, each containing a predetermined amount of a compound of thepresent invention as an active ingredient. An oligomer of the presentinvention may also be administered as a bolus, electuary or paste.

In solid dosage forms of the invention for oral administration(capsules, tablets, pills, dragees, powders, granules, trouches and thelike), the active ingredient may be mixed with one or morepharmaceutically-acceptable carriers, such as sodium citrate ordicalcium phosphate, and/or any of the following: (1) fillers orextenders, such as starches, lactose, sucrose, glucose, mannitol, and/orsilicic acid; (2) binders, such as, for example, carboxymethylcellulose,alginates, gelatin, polyvinyl pyrrolidone, sucrose and/or acacia; (3)humectants, such as glycerol; (4) disintegrating agents, such asagar-agar, calcium carbonate, potato or tapioca starch, alginic acid,certain silicates, and sodium carbonate; (5) solution retarding agents,such as paraffin; (6) absorption accelerators, such as quaternaryammonium compounds and surfactants, such as poloxamer and sodium laurylsulfate; (7) wetting agents, such as, for example, cetyl alcohol,glycerol monostearate, and non-ionic surfactants; (8) absorbents, suchas kaolin and bentonite clay; (9) lubricants, such as talc, calciumstearate, magnesium stearate, solid polyethylene glycols, sodium laurylsulfate, zinc stearate, sodium stearate, stearic acid, and mixturesthereof; (10) coloring agents; and (11) controlled release agents suchas crospovidone or ethyl cellulose. In the case of capsules, tablets andpills, the pharmaceutical compositions may also comprise bufferingagents. Solid compositions of a similar type may also be employed asfillers in soft and hard-shelled gelatin capsules using such excipientsas lactose or milk sugars, as well as high molecular weight polyethyleneglycols and the like.

A tablet may be made by compression or molding, optionally with one ormore accessory ingredients. Compressed tablets may be prepared usingbinder (e.g., gelatin or hydroxypropylmethyl cellulose), lubricant,inert diluent, preservative, disintegrant (for example, sodium starchglycolate or cross-linked sodium carboxymethyl cellulose),surface-active or dispersing agent. Molded tablets may be made bymolding in a suitable machine a mixture of the powdered compoundmoistened with an inert liquid diluent.

The tablets, and other solid dosage forms of the pharmaceuticalcompositions of the present invention, such as dragees, capsules, pillsand granules, may optionally be scored or prepared with coatings andshells, such as enteric coatings and other coatings well known in thepharmaceutical-formulating art. They may also be formulated so as toprovide slow or controlled release of the active ingredient thereinusing, for example, hydroxypropylmethyl cellulose in varying proportionsto provide the desired release profile, other polymer matrices,liposomes and/or microspheres. They may be formulated for rapid release,e.g., freeze-dried. They may be sterilized by, for example, filtrationthrough a bacteria-retaining filter, or by incorporating sterilizingagents in the form of sterile solid compositions which can be dissolvedin sterile water, or some other sterile injectable medium immediatelybefore use. These compositions may also optionally contain opacifyingagents and may be of a composition that they release the activeingredient(s) only, or preferentially, in a certain portion of thegastrointestinal tract, optionally, in a delayed manner. Examples ofembedding compositions which can be used include polymeric substancesand waxes. The active ingredient can also be in micro-encapsulated form,if appropriate, with one or more of the above-described excipients.

Liquid dosage forms for oral administration of the compounds of theinvention include pharmaceutically acceptable emulsions, microemulsions,solutions, suspensions, syrups and elixirs. In addition to the activeingredient, the liquid dosage forms may contain inert diluents commonlyused in the art, such as, for example, water or other solvents,solubilizing agents and emulsifiers, such as ethyl alcohol, isopropylalcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzylbenzoate, propylene glycol, 1,3-butylene glycol, oils (in particular,cottonseed, groundnut, corn, germ, olive, castor and sesame oils),glycerol, tetrahydrofuryl alcohol, polyethylene glycols and fatty acidesters of sorbitan, and mixtures thereof.

Besides inert diluents, the oral compositions can also include adjuvantssuch as wetting agents, emulsifying and suspending agents, sweetening,flavoring, coloring, perfuming and preservative agents.

Suspensions, in addition to the active compounds, may contain suspendingagents as, for example, ethoxylated isostearyl alcohols, polyoxyethylenesorbitol and sorbitan esters, microcrystalline cellulose, aluminummetahydroxide, bentonite, agar-agar and tragacanth, and mixturesthereof.

Formulations for rectal or vaginal administration may be presented as asuppository, which may be prepared by mixing one or more compounds ofthe invention with one or more suitable nonirritating excipients orcarriers comprising, for example, cocoa butter, polyethylene glycol, asuppository wax or a salicylate, and which is solid at room temperature,but liquid at body temperature and, therefore, will melt in the rectumor vaginal cavity and release the active compound.

Formulations or dosage forms for the topical or transdermaladministration of an oligomer as provided herein include powders,sprays, ointments, pastes, creams, lotions, gels, solutions, patches andinhalants. The active oligomers may be mixed under sterile conditionswith a pharmaceutically-acceptable carrier, and with any preservatives,buffers, or propellants which may be required. The ointments, pastes,creams and gels may contain, in addition to an active compound of thisinvention, excipients, such as animal and vegetable fats, oils, waxes,paraffins, starch, tragacanth, cellulose derivatives, polyethyleneglycols, silicones, bentonites, silicic acid, talc and zinc oxide, ormixtures thereof.

Powders and sprays can contain, in addition to an oligomer of thepresent invention, excipients such as lactose, talc, silicic acid,aluminum hydroxide, calcium silicates and polyamide powder, or mixturesof these substances. Sprays can additionally contain customarypropellants, such as chlorofluorohydrocarbons and volatile unsubstitutedhydrocarbons, such as butane and propane.

Transdermal patches have the added advantage of providing controlleddelivery of an oligomer of the present invention to the body. Suchdosage forms can be made by dissolving or dispersing the oligomer in theproper medium. Absorption enhancers can also be used to increase theflux of the agent across the skin. The rate of such flux can becontrolled by either providing a rate controlling membrane or dispersingthe agent in a polymer matrix or gel, among other methods known in theart.

Pharmaceutical compositions suitable for parenteral administration maycomprise one or more oligomers of the invention in combination with oneor more pharmaceutically-acceptable sterile isotonic aqueous ornonaqueous solutions, dispersions, suspensions or emulsions, or sterilepowders which may be reconstituted into sterile injectable solutions ordispersions just prior to use, which may contain sugars, alcohols,antioxidants, buffers, bacteriostats, solutes which render theformulation isotonic with the blood of the intended recipient orsuspending or thickening agents. Examples of suitable aqueous andnonaqueous carriers which may be employed in the pharmaceuticalcompositions of the invention include water, ethanol, polyols (such asglycerol, propylene glycol, polyethylene glycol, and the like), andsuitable mixtures thereof, vegetable oils, such as olive oil, andinjectable organic esters, such as ethyl oleate. Proper fluidity can bemaintained, for example, by the use of coating materials, such aslecithin, by the maintenance of the required particle size in the caseof dispersions, and by the use of surfactants.

These compositions may also contain adjuvants such as preservatives,wetting agents, emulsifying agents and dispersing agents. Prevention ofthe action of microorganisms upon the subject oligomers may be ensuredby the inclusion of various antibacterial and antifungal agents, forexample, paraben, chlorobutanol, phenol sorbic acid, and the like. Itmay also be desirable to include isotonic agents, such as sugars, sodiumchloride, and the like into the compositions. In addition, prolongedabsorption of the injectable pharmaceutical form may be brought about bythe inclusion of agents which delay absorption such as aluminummonostearate and gelatin.

In some cases, in order to prolong the effect of a drug, it is desirableto slow the absorption of the drug from subcutaneous or intramuscularinjection. This may be accomplished by the use of a liquid suspension ofcrystalline or amorphous material having poor water solubility, amongother methods known in the art. The rate of absorption of the drug thendepends upon its rate of dissolution which, in turn, may depend uponcrystal size and crystalline form. Alternatively, delayed absorption ofa parenterally-administered drug form is accomplished by dissolving orsuspending the drug in an oil vehicle.

Injectable depot forms may be made by forming microencapsule matrices ofthe subject oligomers in biodegradable polymers such aspolylactide-polyglycolide. Depending on the ratio of oligomer topolymer, and the nature of the particular polymer employed, the rate ofoligomer release can be controlled. Examples of other biodegradablepolymers include poly(orthoesters) and poly(anhydrides). Depotinjectable formulations may also prepared by entrapping the drug inliposomes or microemulsions that are compatible with body tissues.

When the oligomers of the present invention are administered aspharmaceuticals, to humans and animals, they can be given per se or as apharmaceutical composition containing, for example, 0.1 to 99% (morepreferably, 10 to 30%) of active ingredient in combination with apharmaceutically acceptable carrier.

As noted above, the formulations or preparations of the presentinvention may be given orally, parenterally, topically, or rectally.They are typically given in forms suitable for each administrationroute. For example, they are administered in tablets or capsule form, byinjection, inhalation, eye lotion, ointment, suppository, etc.administration by injection, infusion or inhalation; topical by lotionor ointment; and rectal by suppositories.

The phrases “parenteral administration” and “administered parenterally”as used herein means modes of administration other than enteral andtopical administration, usually by injection, and includes, withoutlimitation, intravenous, intramuscular, intraarterial, intrathecal,intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal,transtracheal, subcutaneous, subcuticular, intraarticular, subcapsular,subarachnoid, intraspinal and intrasternal injection and infusion.

The phrases “systemic administration,” “administered systemically,”“peripheral administration” and “administered peripherally” as usedherein mean the administration of a compound, drug or other materialother than directly into the central nervous system, such that it entersthe patient's system and, thus, is subject to metabolism and other likeprocesses, for example, subcutaneous administration.

Regardless of the route of administration selected, the oligomers of thepresent invention, which may be used in a suitable hydrated form, and/orthe pharmaceutical compositions of the present invention, may beformulated into pharmaceutically-acceptable dosage forms by conventionalmethods known to those of skill in the art. Actual dosage levels of theactive ingredients in the pharmaceutical compositions of this inventionmay be varied so as to obtain an amount of the active ingredient whichis effective to achieve the desired therapeutic response for aparticular patient, composition, and mode of administration, withoutbeing unacceptably toxic to the patient.

The selected dosage level will depend upon a variety of factorsincluding the activity of the particular oligomer of the presentinvention employed, or the ester, salt or amide thereof, the route ofadministration, the time of administration, the rate of excretion ormetabolism of the particular oligomer being employed, the rate andextent of absorption, the duration of the treatment, other drugs,compounds and/or materials used in combination with the particularoligomer employed, the age, sex, weight, condition, general health andprior medical history of the patient being treated, and like factorswell known in the medical arts.

A physician or veterinarian having ordinary skill in the art can readilydetermine and prescribe the effective amount of the pharmaceuticalcomposition required. For example, the physician or veterinarian couldstart doses of the compounds of the invention employed in thepharmaceutical composition at levels lower than that required in orderto achieve the desired therapeutic effect and gradually increase thedosage until the desired effect is achieved. In general, a suitabledaily dose of a compound of the invention will be that amount of thecompound which is the lowest dose effective to produce a therapeuticeffect. Such an effective dose will generally depend upon the factorsdescribed above. Generally, oral, intravenous, intracerebroventricularand subcutaneous doses of the compounds of this invention for a patient,when used for the indicated effects, will range from about 0.0001 toabout 100 mg per kilogram of body weight per day.

If desired, the effective daily dose of the active compound may beadministered as two, three, four, five, six or more sub-dosesadministered separately at appropriate intervals throughout the day,optionally, in unit dosage forms. In certain situations, dosing is oneadministration per day. In certain embodiments, dosing is one or moreadministration per every 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14days, or every 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 weeks, or every 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 months, as needed, to maintain thedesired expression of a functional dystrophin protein.

Nucleic acid molecules can be administered to cells by a variety ofmethods known to those familiar to the art, including, but notrestricted to, encapsulation in liposomes, by iontophoresis, or byincorporation into other vehicles, such as hydrogels, cyclodextrins,biodegradable nanocapsules, and bioadhesive microspheres, as describedherein and known in the art. In certain embodiments, microemulsificationtechnology may be utilized to improve bioavailability of lipophilic(water insoluble) pharmaceutical agents. Examples include Trimetrine(Dordunoo, S. K., et al., Drug Development and Industrial Pharmacy,17(12), 1685-1713, 1991 and REV 5901 (Sheen, P. C., et al., J Pharm Sci80(7), 712-714, 1991). Among other benefits, microemulsificationprovides enhanced bioavailability by preferentially directing absorptionto the lymphatic system instead of the circulatory system, which therebybypasses the liver, and prevents destruction of the compounds in thehepatobiliary circulation.

In one aspect of invention, the formulations contain micelles formedfrom an oligomer as provided herein and at least one amphiphiliccarrier, in which the micelles have an average diameter of less thanabout 100 nm. More preferred embodiments provide micelles having anaverage diameter less than about 50 nm, and even more preferredembodiments provide micelles having an average diameter less than about30 nm, or even less than about 20 nm.

While all suitable amphiphilic carriers are contemplated, the presentlypreferred carriers are generally those that haveGenerally-Recognized-as-Safe (GRAS) status, and that can both solubilizethe compound of the present invention and microemulsify it at a laterstage when the solution comes into a contact with a complex water phase(such as one found in human gastrointestinal tract). Usually,amphiphilic ingredients that satisfy these requirements have HLB(hydrophilic to lipophilic balance) values of 2-20, and their structurescontain straight chain aliphatic radicals in the range of C-6 to C-20.Examples are polyethylene-glycolized fatty glycerides and polyethyleneglycols.

Examples of amphiphilic carriers include saturated and monounsaturatedpolyethyleneglycolyzed fatty acid glycerides, such as those obtainedfrom fully or partially hydrogenated various vegetable oils. Such oilsmay advantageously consist of tri-, di-, and mono-fatty acid glyceridesand di- and mono-polyethyleneglycol esters of the corresponding fattyacids, with a particularly preferred fatty acid composition includingcapric acid 4-10, capric acid 3-9, lauric acid 40-50, myristic acid14-24, palmitic acid 4-14 and stearic acid 5-15%. Another useful classof amphiphilic carriers includes partially esterified sorbitan and/orsorbitol, with saturated or mono-unsaturated fatty acids (SPAN-series)or corresponding ethoxylated analogs (TWEEN-series).

Commercially available amphiphilic carriers may be particularly useful,including Gelucire-series, Labrafil, Labrasol, or Lauroglycol (allmanufactured and distributed by Gattefosse Corporation, Saint Priest,France), PEG-mono-oleate, PEG-di-oleate, PEG-mono-laurate anddi-laurate, Lecithin, Polysorbate 80, etc (produced and distributed by anumber of companies in USA and worldwide).

In certain embodiments, the delivery may occur by use of liposomes,nanocapsules, microparticles, microspheres, lipid particles, vesicles,and the like, for the introduction of the compositions of the presentinvention into suitable host cells. In particular, the compositions ofthe present invention may be formulated for delivery either encapsulatedin a lipid particle, a liposome, a vesicle, a nanosphere, a nanoparticleor the like. The formulation and use of such delivery vehicles can becarried out using known and conventional techniques.

Hydrophilic polymers suitable for use in the present invention are thosewhich are readily water-soluble, can be covalently attached to avesicle-forming lipid, and which are tolerated in vivo without toxiceffects (i.e., are biocompatible). Suitable polymers includepolyethylene glycol (PEG), polylactic (also termed polylactide),polyglycolic acid (also termed polyglycolide), a polylactic-polyglycolicacid copolymer, and polyvinyl alcohol. In certain embodiments, polymershave a molecular weight of from about 100 or 120 daltons up to about5,000 or 10,000 daltons, or from about 300 daltons to about 5,000daltons. In other embodiments, the polymer is polyethyleneglycol havinga molecular weight of from about 100 to about 5,000 daltons, or having amolecular weight of from about 300 to about 5,000 daltons. In certainembodiments, the polymer is polyethyleneglycol of 750 daltons(PEG(750)). Polymers may also be defined by the number of monomerstherein; a preferred embodiment of the present invention utilizespolymers of at least about three monomers, such PEG polymers consistingof three monomers (approximately 150 daltons).

Other hydrophilic polymers which may be suitable for use in the presentinvention include polyvinylpyrrolidone, polymethoxazoline,polyethyloxazoline, polyhydroxypropyl methacrylamide,polymethacrylamide, polydimethylacrylamide, and derivatized cellulosessuch as hydroxymethylcellulose or hydroxyethylcellulose.

In certain embodiments, a formulation of the present invention comprisesa biocompatible polymer selected from the group consisting ofpolyamides, polycarbonates, polyalkylenes, polymers of acrylic andmethacrylic esters, polyvinyl polymers, polyglycolides, polysiloxanes,polyurethanes and co-polymers thereof, celluloses, polypropylene,polyethylenes, polystyrene, polymers of lactic acid and glycolic acid,polyanhydrides, poly(ortho)esters, poly(butic acid), poly(valeric acid),poly(lactide-co-caprolactone), polysaccharides, proteins, polyhyaluronicacids, polycyanoacrylates, and blends, mixtures, or copolymers thereof.

Cyclodextrins are cyclic oligosaccharides, consisting of 6, 7 or 8glucose units, designated by the Greek letter α, β, or γ, respectively.The glucose units are linked by α-1,4-glucosidic bonds. As a consequenceof the chair conformation of the sugar units, all secondary hydroxylgroups (at C-2, C-3) are located on one side of the ring, while all theprimary hydroxyl groups at C-6 are situated on the other side. As aresult, the external faces are hydrophilic, making the cyclodextrinswater-soluble. In contrast, the cavities of the cyclodextrins arehydrophobic, since they are lined by the hydrogen of atoms C-3 and C-5,and by ether-like oxygens. These matrices allow complexation with avariety of relatively hydrophobic compounds, including, for instance,steroid compounds such as 17α-estradiol (see, e.g., van Uden et al.Plant Cell Tiss. Org. Cult. 38:1-3-113 (1994)). The complexation takesplace by Van der Waals interactions and by hydrogen bond formation. Fora general review of the chemistry of cyclodextrins, see, Wenz, Agnew.Chem. Int. Ed. Engl., 33:803-822 (1994).

The physico-chemical properties of the cyclodextrin derivatives dependstrongly on the kind and the degree of substitution. For example, theirsolubility in water ranges from insoluble (e.g.,triacetyl-beta-cyclodextrin) to 147% soluble (w/v)(G-2-beta-cyclodextrin). In addition, they are soluble in many organicsolvents. The properties of the cyclodextrins enable the control oversolubility of various formulation components by increasing or decreasingtheir solubility.

Numerous cyclodextrins and methods for their preparation have beendescribed. For example, Parmeter (I), et al. (U.S. Pat. No. 3,453,259)and Gramera, et al. (U.S. Pat. No. 3,459,731) described electroneutralcyclodextrins. Other derivatives include cyclodextrins with cationicproperties [Parmeter (II), U.S. Pat. No. 3,453,257], insolublecrosslinked cyclodextrins (Solms, U.S. Pat. No. 3,420,788), andcyclodextrins with anionic properties [Parmeter (III), U.S. Pat. No.3,426,011]. Among the cyclodextrin derivatives with anionic properties,carboxylic acids, phosphorous acids, phosphinous acids, phosphonicacids, phosphoric acids, thiophosphonic acids, thiosulphinic acids, andsulfonic acids have been appended to the parent cyclodextrin [see,Parmeter (III), supra]. Furthermore, sulfoalkyl ether cyclodextrinderivatives have been described by Stella, et al. (U.S. Pat. No.5,134,127).

Liposomes consist of at least one lipid bilayer membrane enclosing anaqueous internal compartment. Liposomes may be characterized by membranetype and by size. Small unilamellar vesicles (SUVs) have a singlemembrane and typically range between 0.02 and 0.05 μm in diameter; largeunilamellar vesicles (LUVS) are typically larger than 0.05 μm.Oligolamellar large vesicles and multilamellar vesicles have multiple,usually concentric, membrane layers and are typically larger than 0.1μm. Liposomes with several nonconcentric membranes, i.e., severalsmaller vesicles contained within a larger vesicle, are termedmultivesicular vesicles.

One aspect of the present invention relates to formulations comprisingliposomes containing an oligomer of the present invention, where theliposome membrane is formulated to provide a liposome with increasedcarrying capacity. Alternatively or in addition, the compound of thepresent invention may be contained within, or adsorbed onto, theliposome bilayer of the liposome. An oligomer of the present inventionmay be aggregated with a lipid surfactant and carried within theliposome's internal space; in these cases, the liposome membrane isformulated to resist the disruptive effects of the activeagent-surfactant aggregate.

According to one embodiment of the present invention, the lipid bilayerof a liposome contains lipids derivatized with polyethylene glycol(PEG), such that the PEG chains extend from the inner surface of thelipid bilayer into the interior space encapsulated by the liposome, andextend from the exterior of the lipid bilayer into the surroundingenvironment.

Active agents contained within liposomes of the present invention are insolubilized form. Aggregates of surfactant and active agent (such asemulsions or micelles containing the active agent of interest) may beentrapped within the interior space of liposomes according to thepresent invention. A surfactant acts to disperse and solubilize theactive agent, and may be selected from any suitable aliphatic,cycloaliphatic or aromatic surfactant, including but not limited tobiocompatible lysophosphatidylcholines (LPGs) of varying chain lengths(for example, from about C14 to about C20). Polymer-derivatized lipidssuch as PEG-lipids may also be utilized for micelle formation as theywill act to inhibit micelle/membrane fusion, and as the addition of apolymer to surfactant molecules decreases the CMC of the surfactant andaids in micelle formation. Preferred are surfactants with CMOs in themicromolar range; higher CMC surfactants may be utilized to preparemicelles entrapped within liposomes of the present invention.

Liposomes according to the present invention may be prepared by any of avariety of techniques that are known in the art. See, e.g., U.S. Pat.No. 4,235,871; Published PCT applications WO 96/14057; New RRC,Liposomes: A practical approach, IRL Press, Oxford (1990), pages 33-104;Lasic DD, Liposomes from physics to applications, Elsevier SciencePublishers BV, Amsterdam, 1993. For example, liposomes of the presentinvention may be prepared by diffusing a lipid derivatized with ahydrophilic polymer into preformed liposomes, such as by exposingpreformed liposomes to micelles composed of lipid-grafted polymers, atlipid concentrations corresponding to the final mole percent ofderivatized lipid which is desired in the liposome. Liposomes containinga hydrophilic polymer can also be formed by homogenization, lipid-fieldhydration, or extrusion techniques, as are known in the art.

In another exemplary formulation procedure, the active agent is firstdispersed by sonication in a lysophosphatidylcholine or other low CMCsurfactant (including polymer grafted lipids) that readily solubilizeshydrophobic molecules. The resulting micellar suspension of active agentis then used to rehydrate a dried lipid sample that contains a suitablemole percent of polymer-grafted lipid, or cholesterol. The lipid andactive agent suspension is then formed into liposomes using extrusiontechniques as are known in the art, and the resulting liposomesseparated from the unencapsulated solution by standard columnseparation.

In one aspect of the present invention, the liposomes are prepared tohave substantially homogeneous sizes in a selected size range. Oneeffective sizing method involves extruding an aqueous suspension of theliposomes through a series of polycarbonate membranes having a selecteduniform pore size; the pore size of the membrane will correspond roughlywith the largest sizes of liposomes produced by extrusion through thatmembrane. See e.g., U.S. Pat. No. 4,737,323 (Apr. 12, 1988). In certainembodiments, reagents such as DharmaFECT® and Lipofectamine® may beutilized to introduce polynucleotides or proteins into cells.

The release characteristics of a formulation of the present inventiondepend on the encapsulating material, the concentration of encapsulateddrug, and the presence of release modifiers. For example, release can bemanipulated to be pH dependent, for example, using a pH sensitivecoating that releases only at a low pH, as in the stomach, or a higherpH, as in the intestine. An enteric coating can be used to preventrelease from occurring until after passage through the stomach. Multiplecoatings or mixtures of cyanamide encapsulated in different materialscan be used to obtain an initial release in the stomach, followed bylater release in the intestine. Release can also be manipulated byinclusion of salts or pore forming agents, which can increase wateruptake or release of drug by diffusion from the capsule. Excipientswhich modify the solubility of the drug can also be used to control therelease rate. Agents which enhance degradation of the matrix or releasefrom the matrix can also be incorporated. They can be added to the drug,added as a separate phase (i.e., as particulates), or can beco-dissolved in the polymer phase depending on the compound. In mostcases the amount should be between 0.1 and thirty percent (w/w polymer).Types of degradation enhancers include inorganic salts such as ammoniumsulfate and ammonium chloride, organic acids such as citric acid,benzoic acid, and ascorbic acid, inorganic bases such as sodiumcarbonate, potassium carbonate, calcium carbonate, zinc carbonate, andzinc hydroxide, and organic bases such as protamine sulfate, spermine,choline, ethanolamine, diethanolamine, and triethanolamine andsurfactants such as Tween® and Pluronic®. Pore forming agents which addmicrostructure to the matrices (i.e., water soluble compounds such asinorganic salts and sugars) are added as particulates. The range istypically between one and thirty percent (w/w polymer).

Uptake can also be manipulated by altering residence time of theparticles in the gut. This can be achieved, for example, by coating theparticle with, or selecting as the encapsulating material, a mucosaladhesive polymer. Examples include most polymers with free carboxylgroups, such as chitosan, celluloses, and especially polyacrylates (asused herein, polyacrylates refers to polymers including acrylate groupsand modified acrylate groups such as cyanoacrylates and methacrylates).

An oligomer may be formulated to be contained within, or, adapted torelease by a surgical or medical device or implant. In certain aspects,an implant may be coated or otherwise treated with an oligomer. Forexample, hydrogels, or other polymers, such as biocompatible and/orbiodegradable polymers, may be used to coat an implant with thecompositions of the present invention (i.e., the composition may beadapted for use with a medical device by using a hydrogel or otherpolymer). Polymers and copolymers for coating medical devices with anagent are well-known in the art. Examples of implants include, but arenot limited to, stents, drug-eluting stents, sutures, prosthesis,vascular catheters, dialysis catheters, vascular grafts, prostheticheart valves, cardiac pacemakers, implantable cardioverterdefibrillators, IV needles, devices for bone setting and formation, suchas pins, screws, plates, and other devices, and artificial tissuematrices for wound healing.

In addition to the methods provided herein, the oligomers for useaccording to the invention may be formulated for administration in anyconvenient way for use in human or veterinary medicine, by analogy withother pharmaceuticals. The antisense oligomers and their correspondingformulations may be administered alone or in combination with othertherapeutic strategies in the treatment of muscular dystrophy, such asmyoblast transplantation, stem cell therapies, administration ofaminoglycoside antibiotics, proteasome inhibitors, and up-regulationtherapies (e.g., upregulation of utrophin, an autosomal paralogue ofdystrophin).

The routes of administration described are intended only as a guidesince a skilled practitioner will be able to determine readily theoptimum route of administration and any dosage for any particular animaland condition. Multiple approaches for introducing functional newgenetic material into cells, both in vitro and in vivo have beenattempted (Friedmann (1989) Science, 244:1275-1280). These approachesinclude integration of the gene to be expressed into modifiedretroviruses (Friedmann (1989) supra; Rosenberg (1991) Cancer Research51(18), suppl.: 5074S-5079S); integration into non-retrovirus vectors(e.g., adeno-associated viral vectors) (Rosenfeld, et al. (1992) Cell,68:143-155; Rosenfeld, et al. (1991) Science, 252:431-434); or deliveryof a transgene linked to a heterologous promoter-enhancer element vialiposomes (Friedmann (1989), supra; Brigham, et al. (1989) Am. J. Med.Sci., 298:278-281; Nabel, et al. (1990) Science, 249:1285-1288;Hazinski, et al. (1991) Am. J. Resp. Cell Molec. Biol., 4:206-209; andWang and Huang (1987) Proc. Natl. Acad. Sci. (USA), 84:7851-7855);coupled to ligand-specific, cation-based transport systems (Wu and Wu(1988) J. Biol. Chem., 263:14621-14624) or the use of naked DNA,expression vectors (Nabel et al. (1990), supra); Wolff et al. (1990)Science, 247:1465-1468). Direct injection of transgenes into tissueproduces only localized expression (Rosenfeld (1992) supra); Rosenfeldet al. (1991) supra; Brigham et al. (1989) supra; Nabel (1990) supra;and Hazinski et al. (1991) supra). The Brigham et al. group (Am. J. Med.Sci. (1989) 298:278-281 and Clinical Research (1991) 39 (abstract)) havereported in vivo transfection only of lungs of mice following eitherintravenous or intratracheal administration of a DNA liposome complex.An example of a review article of human gene therapy procedures is:Anderson, Science (1992) 256:808-813.

V. KITS

The invention also provides kits for treatment of a patient with agenetic disease which kit comprises at least an antisense molecule(e.g., an antisense oligomer set forth in SEQ ID NOs: 1 and 9-13),packaged in a suitable container, together with instructions for itsuse. The kits may also contain peripheral reagents such as buffers,stabilizers, etc. Those of ordinary skill in the field should appreciatethat applications of the above method has wide application foridentifying antisense molecules suitable for use in the treatment ofmany other diseases.

VI. EXAMPLES

Although the foregoing invention has been described in some detail byway of illustration and example for purposes of clarity ofunderstanding, it will be readily apparent to one of ordinary skill inthe art in light of the teachings of this invention that certain changesand modifications may be made thereto without departing from the spiritor scope of the appended claims. The following examples are provided byway of illustration only and not by way of limitation. Those of skill inthe art will readily recognize a variety of noncritical parameters thatcould be changed or modified to yield essentially similar results.

Materials and Methods Cells and Tissue Culture Treatment Conditions

Human Rhabdomyosarcoma cells (ATCC, CCL-136; RD cells) were seeded intotissue culture-treated T75 flasks (Nunc) at 1.5×10⁶ cells/flask in 24 mLof warmed DMEM with L-Glutamine (HyClone), 10% fetal bovine serum, and1% Penicillin-Streptomycin antibiotic solution (CelGro); after 24 hours,media was aspirated, cells were washed once in warmed PBS, and freshmedia was added. Cells were grown to 80% confluence in a 37° C.incubator at 5.0% CO2 and harvested using trypsin. Lyophilizedphosphorodiamidate morpholino oligomers (PMOs) were re-suspended atapproximately 2.0 mM in nuclease-free water; to verify molarity, PMOsolutions were measured using a NanoDrop 2000 spectrophotometer (ThermoScientific). PMOs were delivered to RD cells using nucleoporationaccording to the manufacturer's instructions and the SG kit (Lonza).PMOs were tested at various concentrations (e.g., 2.5, 5, 12.5 and 25micromolar). Cells were incubated for 24 hours post nucleoporation at3×10⁵ cells per well of a 12-well plate (n=3) and then subjected to RNAextraction as described below.

Primary human myoblasts were cultured in Skeletal Muscle Cell GrowthMedia (PromoCell) using standard techniques. Nucleoporation of the PMOsat various concentrations was done as described for RD cells above.Cells were then plated in triplicate wells of a 12-well plate inPromoCell growth media and allowed to incubate for 24 hours before RNAextraction as described below.

RNA Extraction and PCR Amplification

RNA was extracted from PMO-treated cells (RD cells or primary humanmyoblasts) using the RNAspin 96 well RNA isolation kit from GEHealthcare and subjected to nested RT-PCR using standard techniques andthe following primer pairs. Outer primers: forward5′-CAATGCTCCTGACCTCTGTGC-3′ (SEQ ID NO: 39), reverse5′-GCTCTTTTCCAGGTTCAAGTGG-3′ (SEQ ID NO: 40); inner primers: forward5′-GTCTACAACAAAGCTCAGGTCG-3′ (SEQ ID NO: 41), reverse5′-GCAATGTTATCTGCTTCCTCCAACC-3′ (SEQ ID NO: 42). Exon skipping wasmeasured using the Caliper LabChip bioanalyzer and the % exon skipping(i.e., band intensity of the exon-skipped product relative to the fulllength PCR product) was graphed as shown in FIGS. 2 and 3.

Example 1 Exon 44 Skipping

A series of antisense oligomers that target human dystrophin exon 44were designed and synthesized as follows:

SEQ Description Sequence ID NO H44A(-07+17) CAGATCTGTCAAATCGCCTGCAGG 1H44A(-07+20) CAACAGATCTGTCAAATCGCCTGCAGG 2 H44A(-07+22)CTCAACAGATCTGTCAAATCGCCTGCAGG 3 H44A(+77+101) GTGTCTTTCTGAGAAACTGTTCAGC4 H44A(+64+91) GAGAAACTGTTCAGCTTCTGTTAGCCAC 5 H44A(+62+89)GAAACTGTTCAGCTTCTGTTAGCCACTG 6 H44A(+62+85) CTGTTCAGCTTCTGTTAGCCACTG 7

The antisense oligomers above were evaluated for exon skipping efficacyby treating RD cells at the various indicated concentrations. In theseexperiments, published antisense oligomers corresponding to H44A(−06+14)and H44A(+85+104) (U.S. Pat. No. 8,232,384; SEQ ID NOs: 167 and 165,respectively) and H44A(−06+20), H44A(−09+17), H44A(+59+85) andH44A(+65+90) (WO2011/057350; SEQ ID NOs: 68, 220, 54 and 10,respectively) were used as comparative oligomers. As shown in FIG. 2,oligomer H44A(−07+17) (SEQ ID NO: 1) was highly effective at inducingexon 44 skipping in RD cells compared to known sequences. As shown inFIG. 3, H44A(+62+89) (SEQ ID NO: 6) was highly effective in inducingexon 44 skipping in cultured RD cells compared to other highly activeantisense oligonucleotides known in the art.

All publications and patent applications cited in this specification areherein incorporated by reference as if each individual publication orpatent application were specifically and individually indicated to beincorporated by reference.

REFERENCES

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SEQUENCE LISTING SEQ Description Sequence ID NO H44A(-07+17)CAGATCTGTCAAATCGCCTGCAGG  1 H44A(-07+20) CAACAGATCTGTCAAATCGCCTGCAGG  2H44A(-07+22) CTCAACAGATCTGTCAAATCGCCTGCAGG  3 H44A(+77+101)GTGTCTTTCTGAGAAACTGTTCAGC  4 H44A(+64+91) GAGAAACTGTTCAGCTTCTGTTAGCCAC 5 H44A(+62+89) GAAACTGTTCAGCTTCTGTTAGCCACTG  6 H44A(+62+85)CTGTTCAGCTTCTGTTAGCCACTG  7 H44A(-06+14) ATCTGTCAAATCGCCTGCAG  8H44A(+85+104) TTTGTGTCTTTCTGAGAAAC  9 H44A(+61+84)TGTTCAGCTTCTGTTAGCCACTGA 10 H44A(-10+15) GATCTGTCAAATCGCCTGCAGGTAA 11H44A(+64+88) AAACTGTTCAGCTTCTGTTAGCCAC 12 H44A(+79+103)TTGTGTCTTTCTGAGAAACTGTTCA 13 H44A(-06+20) CAACAGATCTGTCAAATCGCCTGCAG 14H44A(-09+17) CAGATCTGTCAAATCGCCTGCAGGTA 15 H44A(+59+85)CTGTTCAGCTTCTGTTAGCCACTGATT 16 H44A(+59+89)GAAACTGTTCAGCTTCTGTTAGCCACTGATT 17 H44A(+65+90)AGAAACTGTTCAGCTTCTGTTAGCCA 18 rTAT RRRQRRKKR 19 Tat RKKRRQRRR 20 R₉F₂RRRRRRRRRFF 21 R₅F₂R₄ RRRRRFFRRRR 22 R₄ RRRR 23 R₅ RRRRR 24 R₆ RRRRRR 25R₇ RRRRRRR 26 R₈ RRRRRRRR 27 R₉ RRRRRRRRR 28 (RX)₈ RXRXRXRXRXRXRXRX 29(RAhxR)₄; RAhxRRAhxRRAhxRRAhxR 30 (P007) (RAhxR)₅;RAhxRRAhxRRAhxRRAhxRRAhxR 31 (CP04057) (RAhxRRBR)₂; RAhxRRBRRAhxRRBR 32(CP06062) (RAR)₄F₂ RARRARRARRARFF 33 (RGR)₄F₂ RGRRGRRGRRGRFF 34 PrimerCTTGGACAGAACTTACCGACTGG 35 Primer GTTTCTTCCAAAGCAGCCTCTCG 36 PrimerGCAGGATTTGGAACAGAGGCG 37 Primer CATCTACATTTGTCTGCCACTGG 38

1. An antisense oligonucleotide of 20 to 50 bases in length comprising at least 10 consecutive bases of a sequence selected from the group consisting of: SEQ ID NOs: 1-7, wherein the oligonucleotide specifically hybridizes to an exon 44 target region of the human dystrophin pre-mRNA, wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide induces exon 44 skipping, and wherein thymine bases are optionally uracil bases; or a pharmaceutically acceptable salt thereof.
 2. The antisense oligonucleotide of claim 1, comprising a base sequence selected from the group consisting of SEQ ID NOs: 1-7.
 3. The antisense oligonucleotide of claim 1, consisting of a base sequence selected from the group consisting of SEQ ID NOs: 1-7. 4-14. (canceled)
 15. The antisense oligonucleotide of claim 3, wherein the oligonucleotide is chemically linked to one or more moieties or conjugates that enhance the activity, cellular distribution, or cellular uptake of the antisense oligonucleotide.
 16. (canceled)
 17. The antisense oligonucleotide of claim 15, wherein the oligonucleotide is chemically linked to a polyethylene glycol moiety.
 18. An antisense oligonucleotide of 20 to 50 bases in length comprising at least 10 consecutive bases of a base sequence complementary to an exon 44 target region of the human dystrophin pre-mRNA designated as an annealing site selected from the group consisting of: H44A(−07+17), H44A(−07+20), H44A(−07+22), H44A(+77+101), H44A(+64+91), H44A(+62+89), and H44A(+62+85), wherein the antisense oligonucleotide is a morpholino antisense oligonucleotide, and wherein the antisense oligonucleotide induces exon 44 skipping; or a pharmaceutically acceptable salt thereof.
 19. The antisense oligonucleotide of claim 18, wherein the antisense oligonucleotide is 20 to 30 bases in length.
 20. The antisense oligonucleotide of claim 19, wherein in the base sequence the thymine bases are uracil bases. 21-31. (canceled)
 32. The antisense oligonucleotide of claim 20, wherein the oligonucleotide is chemically linked to one or more moieties or conjugates that enhance the activity, cellular distribution, or cellular uptake of the antisense oligonucleotide.
 33. (canceled)
 34. The antisense oligonucleotide of claim 32, wherein the oligonucleotide is chemically linked to a polyethylene glycol moiety. 35-37. (canceled)
 38. A pharmaceutical composition, comprising an antisense oligonucleotide of claim 1, or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier.
 39. A method of treating Duchenne muscular dystrophy in need thereof, comprising administering to the patient an effective amount of a pharmaceutical composition of claim
 38. 40-42. (canceled)
 43. A pharmaceutical composition, comprising an antisense oligonucleotide of claim 18, or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier.
 44. A method of treating Duchenne muscular dystrophy in a patient in need thereof, comprising administering to the patient an effective amount of a pharmaceutical composition of claim
 43. 